MedicaidPrior AuthMedium impact
Updated Cystic Fibrosis (CF) Prior Authorization Request Form for Orkambi, Kalydeco and Symdeko pdf
Connecticut Medicaid (HUSKY Health)·CT · Pulmonology, Pediatrics, Family Medicine +1 more·Prior Authorization
Effective date
May 1, 2018
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY programs) now requires prior authorization for Kalydeco and Symdeko cystic fibrosis medications effective May 1, 2018, using a new unified prior authorization form that also covers Orkambi. Providers must use the updated CF PA Request Form for all three medications instead of the previous Orkambi-only form.
Action Required
By May 1, 2018: Billing team must obtain prior authorization for Kalydeco and Symdeko prescriptions for Connecticut HUSKY members using the new unified Cystic Fibrosis PA Request Form available at www.ctdssmap.com. Replace old Orkambi-only form with new combined form for all three CF medications (Orkambi, Kalydeco, Symdeko). Ensure providers complete age and genetic mutation requirements before prescribing.