Diagnosis: Bronchiectasis, Sarcoidosis.
Treatment: Cayston (inhaled aztreonam).

The insurer denied coverage for Cayston (inhaled aztreonam). The denial is overturned.

This is a female patient, who has been diagnosed with sarcoidosis, sickle cell disease, and bronchiectasis. She utilizes oxygen therapy primarily at night. This patient has been treated for bronchiectasis exacerbations numerous times with ciprofloxacin and levofloxacin; however, she continues to have symptoms of persistent cough with copious sputum and shortness of breath. Cultures consistently show moderate Pseudomonas aeruginosa. The patient has been trialed on inhaled tobramycin but she developed ototoxicity. Given the inability to utilize the above, with the failure of treatment with ciprofloxacin and levofloxacin, the patient has limited options. She does not have cystic fibrosis; however, she does have positive cultures; therefore, it was recommended that she utilize the requested Cayston.

Scientific evidence in peer-reviewed literature supports a result of improvement in health outcome. The indication for the use of this medication is for the treatment of respiratory infections, including those of pseudomonas in cystic fibrosis patients, and is well supported by the available evidence. The use of this medication for the treatment of respiratory infections with the intent of improving symptoms in non-cystic fibrosis patients with bronchiectasis has been studied and supports efficacy.

The FDA has only approved this medication for the use of respiratory infections in patients with cystic fibrosis. There is no FDA approved indication for the treatment of respiratory infections in non-cystic fibrosis patients; however, the medication is supported for off-label use based on literature.

This patient is a good candidate for Cayston. There is current evidence that this medication improves symptoms in non-cystic fibrosis patients. She has been unresponsive to other alternative treatment and would be a good candidate for Cayston at this time. The requested service is likely to be more beneficial than any of the standard treatments/procedures for this patient.

The carrier's denial of coverage for Cayston, inhaled medication, should be overturned.