New pulmonary fibrosis drugs put guidelines in focus, Prusi says | AMCP Nexus 2026

As more treatments for fibrosing interstitial lung diseases (ILDs) reach the market, health plans should look to international treatment guidelines when setting coverage criteria, according to Rachael Prusi, Pharm.D., MSGH, director of clinical specialty solutions at Prime Therapeutics.

Prusi co-presented a session at AMCP Nexus 2026 on how managed care can improve diagnosis, care coordination and treatment for these progressive lung-scarring diseases. In this second part of her interview with Managed Healthcare Executive, she discusses coverage policy and what good care coordination looks like.

Following the evidence

Jascayd (nerandomilast), which the FDA approved in 2025 for both IPF and PPF, and several drugs in late-stage trials are expanding treatment options for these patients. Prusi said health plans should watch where the evidence goes, including which drugs patients should try first and which work best together.

“We also have very robust international guidelines, and they can help really provide some evidence-based criteria that health plans should consider using,” she said.

The main message of those guidelines is that every patient should start an antifibrotic as soon as possible, Prusi said. Two of the three available antifibrotics carry an FDA-approved indication for the progressive form of the disease, and patients with progressive disease should try to be on one of those two. She added that simplifying the prior authorization process is an opportunity for plans.

A team approach

Good care coordination relies on a multidisciplinary team, Prusi said. Ideally, that team includes ILD experts, a pharmacist, social workers and case managers.

Health plans can support that team with strong care management programs. Prusi said plans may be able to identify these patients early through ICD-10 diagnosis codes or a prior authorization request for an antifibrotic. Either one could trigger a referral to case management.

From there, a case manager or pharmacist can help patients manage side effects and stay on their medication. That support matters because patients may not notice a change right away.

“You may not feel immediately better when you start this medication, but it's still really important to be able to preserve your lung function to stay on it,” she said.