Hi NatalieB,
I'm so sorry to hear about your denial. My 14 yo daughter with CF is on Kalydeco off label as well. She is F508del and 621 +1G>T (splicing mutation). She was on Kalydeco for one month in April before prior authorization was required through BCBS. Her FEV1 went up 11% in one month (from 46% to 57%). She was denied access for 3 months, even after a 4 page formal appeal from our doc. In only 2 months off of Kalydeco, her FEV1 fell to 37%. Finally, one day in July when she had a coughing spell that lasted about 10 minutes straight, I was distrought and I decided to call the pharmacy myself (BCBS uses Medco/Accredo) and I asked to speak to someone in the appeals dept. I got a pharmacist who patiently listened to me and I literally broke down telling him our story. At that time I not only had the positive results of Kalydeco, but the negative ones from being off of it as well. He asked that I send the data directly to him and label it as "additional information to first appeal." That was on a Friday and by the following Wednesday, we had approval! However, the approval runs out this month and we are submitting new data again this week and praying that the approval goes through once again. Since July 20th, my daughter's FEV1 has improved 24%! Last week she was 61% FEV1 on her PFT. She had lost 3 pounds in May and June and has not only gained that weight back, but 10 more to go with it for a total of 13 pounds. She has also grown 1.5 inches in height in 10 weeks and ran a 5K on August 29th. The difference in this child is amazing. I will not go down without a fight if she is denied again! So, all of this to say, don't give up. Call and ask for someone in the appeals department. Send them your data and I hope you don't have to wait until you decline, like we did, before someone sees the light. However, if you continue to be denied, I would STRONGLY recommend getting PFT's monthly and getting your sweat chloride retested since you saw a drop. It is really all about the data in the end to those who are just looking at cost and numbers. I wish you all the best and hope you get good news very soon!