BACKGROUND: Although modulator therapies have proven effective in cystic fibrosis (CF) access is limited due to reimbursement issues in Turkey. We aimed to examine anxiety and depression levels of people with CF (pwCF) and their caregivers according to their access to modulator treatment. METHODS: Participants genetically eligible for elexacaftor/tezacaftor/ivacaftor (ETI) were divided into Group 1 (access via court decision, not yet on treatment) and Group 2 (unable to access due to reimbursement issues). Genetically ineligible participants formed Group 3. All pwCF and parents of those under 18 were screened for depression by the Patient Health Questionnaire-9 (PHQ-9) and for anxiety by the Generalized Anxiety Disorder-7 (GAD-7). Surveys for Group 1 patients were conducted just before starting ETI. Binary logistic regression analysis was performed to evaluate the effects of independent variables on anxiety and depression in pwCF and their primary caregivers. RESULTS: A total of 389 pwCF and 285 caregivers were included. Group 3 (ineligible) had the highest depression rate (72.9%, n = 35), while Group 1 (pre-ETI) had the lowest (50.0%, n = 35). Median PHQ-9 scores were significantly lower in Group 1 (p <
0.006). Anxiety rates were higher in Groups 2 and 3 compared to Group 1 (p = 0.011 and p = 0.003, respectively). Access to ETI reduced the odds of anxiety by 67.7% (p = 0.029). Caregiver GAD-7 scores showed a weak negative correlation with pwCF age (r = -0.117). CONCLUSION: Limited access to modulator therapies is associated with higher depression and anxiety symptoms among pwCF. Addressing these barriers is critical to improving their well-being.