Cystic Fibrosis

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Generic Name Brand Name Form PDL
Status
Current Drug Use Criteria Carveout
‐ Bill FFS
New Drug Evaluation & Updates
sodium chloride for inhalation SODIUM CHLORIDE VIAL-NEB Y   N  
tobramycin in 0.225% sod chlor TOBRAMYCIN AMPUL-NEB Y   N  
aztreonam lysine CAYSTON VIAL-NEB N   N  
elexacaftor/tezacaftor/ivacaft TRIKAFTA GRAN PK SQ N Pharmacy PA N  
ivacaftor KALYDECO GRAN PACK N Pharmacy PA N  
lumacaftor/ivacaftor ORKAMBI GRAN PACK N Pharmacy PA N  
tezacaftor/ivacaftor SYMDEKO TABLET SEQ N Pharmacy PA N  
tobramycin BETHKIS AMPUL-NEB N   N  
tobramycin TOBRAMYCIN AMPUL-NEB N   N  
tobramycin/nebulizer TOBRAMYCIN AMPUL-NEB N   N