Cystic Fibrosis Agents (Oral)
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This policy governs prior authorization and medical necessity for oral CFTR modulators used to treat cystic fibrosis under Washington Apple Health. It applies to providers requesting initial approval, transition therapy, or reauthorization for eligible Apple Health members.
Alyftrek (vanzacaftor/tezacaftor/deutivacaftor) was added to the cystic fibrosis agents covered by the policy.
The pediatric eye examination requirement was removed.
The policy updated medical necessity language and minimum age indications for selected CFTR modulators.
Trikafta granule formulations were added to the dosage and quantity limits.
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