CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Trikafta (elexacaftor/tezacaftor/ivacaftor) — Coverage Criteria

Covers prior authorization criteria, documentation, prescriber requirements, and renewal for Trikafta when used to treat cystic fibrosis in eligible members of Neighborhood Health Plan of Rhode Island.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTrikafta (elexacaftor/tezacaftor/ivacaftor) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit a genetic testing report confirming the presence of an eligible CFTR mutation for prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥2minimum treated age

12 moauth duration

requiredgenotype confirmation

pulmonologistprescriber

F508del/respeligible mutations

Coverage Criteria for Trikafta

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.