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    Kalydeco

    Drug - Kalydeco (ivacaftor) [Vertex]

    June 2017

    Therapeutic area - Cystic Fibrosis

    Approval criteria

    • Patient has diagnosis of cystic fibrosis AND
    • Patient is greater than or equal to 2 years of age AND
    • Patient has one of the following CFTR mutations that is responsive to Kalydeco
    G551D
    c.1652G>A    		 S1255P
    c.3763T>C    		 A1067T
    c.3199G>A    		 D579G
    c.1736A>G    		 K1060T
    c.3179A>C    		 R347H
    c.1040G>A
    G1244E
    c.3731G>A    		 S5 49N
    c.1646G>A    		 A455E
    c.1364C>A    		 E193K
    c.577G>A    		 L206W
    c.617T>G    		 R352Q
    c.1055G>A
    G1349D
    c.4046G>A    		 S549R
    c.1645A>C,
    c.1647T>G    		 D110E
    c.330C>A    		 E56K
    c.166G>A    		 P67L
    c.200C>T    		 R74W
    c.220C>T
    G178R
    c.532G>A    		 R117H
    c.350G>A    		 D110H
    c.328G>C    		 F1052V
    c.3154T>G    		 R1070Q
    c.3209G>A    		 S945L
    c.2834C>T
    G551S
    c.1651G>A    		 D1152H
    c.3454G>C    		 F1074L
    c.3222T>A    		 R1070W
    c.3208C>T    		 S977F
    c.2930C>T
    S1251N
    c.3752G>A    		 D1270N
    c.3808G>A    		 G1069R
    c.3205G>A    		 R117C
    c.349C>T

    Quantity limits

    Quantity Limit = 68 tablets

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

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