How to Help Your Patients Find Bronchitol In Stock: A Provider's Guide

For CF care teams managing adults on Bronchitol (inhaled mannitol), the clinical decision to prescribe is just the beginning. The real challenge often comes in the operational steps: navigating prior authorizations, routing prescriptions to the right specialty pharmacies, coordinating the Bronchitol Tolerance Test (BTT), and helping patients access financial assistance when the cost is prohibitive. This guide is a practical resource for that work.

Step 1: Complete the Bronchitol Tolerance Test (BTT) First

No prescription for Bronchitol maintenance therapy can be written until the patient passes the BTT. The BTT must be performed in a clinical setting under the supervision of a healthcare practitioner who can manage acute bronchospasm. Key points:

Have rescue medication (inhaled short-acting bronchodilator) and resuscitation equipment immediately available

Monitor for bronchospasm, FEV1 decline, oxygen desaturation, and tolerability during the test

Document the BTT result — passing or failing — clearly in the patient's chart

In clinical trials, approximately 8% of patients failed or did not complete the BTT — do not prescribe Bronchitol to these patients

Step 2: Route the Prescription to a Specialty Pharmacy

One of the most common reasons patients don't receive Bronchitol on time is that the prescription was sent to a retail pharmacy that cannot dispense it. Bronchitol is only available through specialty pharmacies. Build this into your practice's prescription workflow:

Maintain a list of specialty pharmacies in your region that are preferred Bronchitol partners

Instruct front desk and prescription staff to always e-prescribe Bronchitol to a specialty pharmacy — never a retail location

Know that specialty pharmacies can ship directly to patients' homes — physical proximity to the pharmacy is not required

Step 3: Submit a Strong Prior Authorization Request

Prior authorization is required by virtually all commercial and Medicaid plans covering Bronchitol. A complete, well-documented PA request significantly reduces delays. Most plans require:

Confirmed diagnosis of cystic fibrosis

Patient age ≥18 years

Documentation that BTT was performed and passed

Baseline FEV1 within the payer's specified range

For plans with step therapy: documentation that dornase alfa or hypertonic saline was tried and was insufficient or not tolerated

If the initial PA is denied, don't give up. Most denials can be successfully appealed with a medical necessity letter citing clinical trial evidence. The Chiesi CareConnect team can provide PA appeal support.

Step 4: Connect Patients With Chiesi CareConnect

Chiesi CareConnect is the manufacturer's patient support program and a major resource for both patients and providers. Services include:

Specialty pharmacy coordination: CareConnect can direct prescriptions to appropriate specialty pharmacy partners

Copay assistance: For commercially insured patients, copay support can significantly reduce out-of-pocket costs (approximately $3,826/month without assistance)

Patient assistance program: Eligible uninsured or underinsured patients may receive free or reduced-cost Bronchitol

PA appeal support: CareConnect representatives can assist with documentation and appeals for insurance denials

Step 5: Use medfinder for Patients Who Need Help Locating a Pharmacy

When a patient is having trouble locating a specialty pharmacy that can fill their Bronchitol prescription, medfinder for providers can help. medfinder calls pharmacies to identify which ones have the medication available, reducing the burden on patients and clinic staff alike.

Step 6: Address Ongoing Monitoring and Adherence

Once your patient has their Bronchitol in hand, monitoring for adherence and tolerability is important:

Confirm pre-medication with a short-acting bronchodilator 5–15 minutes before each dose

Review proper inhaler technique — each of the 10 capsules must be inhaled individually

Remind patients to replace the inhaler after 7 days of use

Monitor for hemoptysis — discontinue Bronchitol if significant hemoptysis occurs

Confirm hypertonic saline is not being used concurrently

For more on the supply landscape, see: Bronchitol Shortage: What Providers Need to Know in 2026.

Also see: How to Help Your Patients Save Money on Bronchitol: A Provider's Guide to Savings Programs.