Tobramycin Inhalation Solution

Drug - Bethkis, Tobi, tobramycin inhalation solution

January 2018

Therapeutic area - Cystic Fibrosis

Preferred Product: Bethkis inhalation solution

Nonpreferred Products: Tobi, generic tobramycin inhalation solution

Criteria

Authorization will be granted for nonpreferred products if the recipient has had a documented:

• Allergic reaction to a specific inactive ingredient in the preferred product
• Adverse reaction to a specific inactive ingredient in the preferred product
• Therapeutic success while taking the nonpreferred product and therapeutic failure while taking the preferred product
• Supporting documentation must be provided at the time of request

Questions?

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