- Kalydeco (ivacaftor), an oral, twice-daily medication developed by Vertex Pharmaceuticals, is a targeted therapy for cystic fibrosis (CF) patients with certain genetic mutations.
- After three CF patients filed a civil suit against Medicaid in Arkansas, The Department of Human Services in Arkansas will no longer require CF patients to used standard therapy for 12 months before becoming eligible for Kalydeco (ivacaftar), a $311,000-per-year drug.
- Although no monetary awards were offered, the relaxed criteria will make it easier for eligible CF patients to gain access to Kalydeco.
In terms of denying coverage for Kalydeco, which is considered one of the most expensive drugs in the world, Arkansas is not alone. Last month, Biopharma Dive reported on patients being denied Kalydeco in the U.K., one of many payers that has so "no" to Kalydeco.
However, it should be noted that the treatment population is small, since it is very targeted to specific genetic mutations. It is a lifelong drug for eligible CF patients that significantly improves lung function and quality of life.
Perhaps most important for supporting the use of Kalydeco is that the eligible treatment population is so small. For example, in Arkansas, only seven patients have been deemed eligible, based on their genetic profile.