Cystic Fibrosis

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NAME
ALSO KNOW AS
DRUG CATEGORY
FORMULARY CATEGORY
WHAT WE COVER
COST SHARE
Cayston Solr 75 Mg (Brand)

Aztreonam Lysine Solr 75Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Kalydeco Pack 25 Mg (Brand)

Ivacaftor Pack 25Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Kalydeco Pack 50 Mg (Brand)

Ivacaftor Pack 50Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Kalydeco Pack 75 Mg (Brand)

Ivacaftor Pack 75Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Kalydeco Tabs 150 Mg (Brand)

Ivacaftor Tabs 150Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Orkambi Pack 100-125 Mg (Brand)

Lumacaftor-Ivacaftor Pack (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Orkambi Pack 150-188 Mg (Brand)

Lumacaftor-Ivacaftor Pack (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Orkambi Tabs 100-125 Mg (Brand)

Lumacaftor-Ivacaftor Tabs (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Orkambi Tabs 200-125 Mg (Brand)

Lumacaftor-Ivacaftor Tabs (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Symdeko Tbpk 100-150 & 150 Mg (Brand)

Tezacaftor-Ivacaftor Tbpk (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Symdeko Tbpk 50-75 & 75 Mg (Brand)

Tezacaftor-Ivacaftor Tbpk (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Tobi Nebu 300 Mg/5Ml (Brand)

Tobramycin Nebu 300Mg/5Ml (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Tobi Podhaler Caps 28 Mg (Brand)

Tobramycin Caps 28Mg (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68
Trikafta Tbpk 100-50-75 & 150 Mg (Brand)

Elexacaftor-Tezacaftor-Ivacaftor Tbpk (Generic)
Cystic Fibrosis
3
Non-Formulary Brand
$68