Dornase Alfa Inhalation Solution (Pulmozyme)

Pulmozyme (dornase alfa) is covered only for the FDA‑approved indication — management of cystic fibrosis in conjunction with standard therapies — and other uses are not covered. Approval requires prescription by or documentation of consultation with a pulmonologist or cystic fibrosis specialist, is granted for up to 12 months, and dosing is limited to 2.5 mg inhaled via nebulizer no more than twice daily with documentation of diagnosis and dosing.

"Pulmozyme is indicated in conjunction with standard therapies for the management of cystic fibrosis."

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