nintedanib (Ofev®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Treatment of idiopathic pulmonary fibrosis (IPF)

Patients must meet the following criteria for the indication(s) above:

  • Diagnosis if IPF by pulmonologist

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • All non-FDA approved uses not listed in the approved indications

Dosing:

  • The recommended dose is 150 mg twice a day with food
  • Should be given 12 hours apart
  • Dose modification is required for adverse events and elevated liver function tests

Approval:

One year


 

Last review date: December 1, 2014