Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO)
Kitabis Pak (tobramycin with nebulizer)
Drugs for the Lungs : Drugs for Cystic Fibrosis
  • Step Therapy: Cystic Fibrosis (CF):
    ST Multiple Generics

  • Available only through Specialty Pharmacy; Limited access;
  • Cystic Fibrosis (CF):
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Documented Mutation in the CFTR Gene: No
    Documented Homozygous F508del Mutation in the CFTR Gene: No
    Pseudomonas Aeruginosa Culture Required: No
    Baseline FEV1 Value (percent predicted): N/A
    FEV1 ImprovementMaintenance for Reauthorization: No
    Liver Function Test Required: No

  • Prior Authorization: Cystic Fibrosis (CF):
    Duration: 1 year(s)

  • Quantity Limit: limit maximum 9.40 mL PER 1 day(s)