HealthNet - All plan years
Kitabis Pak (tobramycin with nebulizer)
Drugs for the Lungs : Drugs for Cystic Fibrosis
  • Cystic Fibrosis (CF):
    Age Requirement: >= 6
    Duration: 1 plan year
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    Documented Mutation in the CFTR Gene: No
    Documented Homozygous F508del Mutation in the CFTR Gene: No
    Pseudomonas Aeruginosa Culture Required: Yes
    Baseline FEV1 Value (percent predicted): N/A
    FEV1 ImprovementMaintenance for Reauthorization: No
    Liver Function Test Required: No

  • Prior Authorization: Cystic Fibrosis (CF):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 6
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Must use AcariaHlth Sp Rx