Cystic Fibrosis Transmembrane Conductance Regulator - Orkambi
Defines prior authorization, medical necessity criteria, and restrictions for Orkambi for treatment of cystic fibrosis in Cigna-administered health benefit plans; applies to clinicians prescribing Orkambi and to prior authorization reviewers.
Updated preferred product criteria to require that for employer plans the patient is ≥ 2 years and has tried and failed or had significant intolerance to Trikafta, or is < 2 years, or is already on Orkambi.
Changed approval language to require documentation that the patient has TWO copies of the F508del mutation in the cystic fibrosis transmembrane conductance regulator gene.
Added a Documentation statement noting documentation is required where indicated and examples of acceptable documentation.
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