Trikafta
Trikafta is a prescription medication that combines elexacaftor, tezacaftor, and ivacaftor to treat cystic fibrosis in patients with at least one F508del mutation. The FDA approved Trikafta in October 2019 for people aged 6 years and older with this genetic mutation.
Most major US health insurance plans, including Blue Cross Blue Shield and UnitedHealthcare, cover Trikafta for eligible members after prior authorization. Medicaid programs in all 50 states list Trikafta on their preferred drug lists as of June 2024.
Out-of-pocket costs for Trikafta can exceed $311,000 per year without insurance coverage. Prior authorization requirements typically include documentation of the patient’s CFTR genotype and previous treatments tried, the Insurance Information Database has reported.
Many commercial insurers require step therapy or proof of medical necessity before approving Trikafta claims. Vertex Pharmaceuticals offers copay assistance programs that reduce monthly out-of-pocket expenses for eligible commercially insured patients to as low as $15 per month.
Insurance denials most commonly cite missing genetic test results or incomplete prior authorization forms according to appeals data from Cystic Fibrosis Foundation Compass (2023).
Is Trikafta covered by insurance?
Yes, Trikafta is covered by insurance. Most health insurance plans will cover medications that are approved by the Food and Drug Administration (FDA). Trikafta has been FDA approved, so it is generally covered under most health insurance policies. Different insurance companies have different rules and regulations, so it is best to consult with your insurer…
See also Trikafta costs, and Trintellix.