Lupkynis — Blue Cross Blue Shield of Alabama

Initial criteria

• BOTH of the following:
• • The patient has a diagnosis of active LN
• AND
• • The patient has tried and had an inadequate response to TWO standard therapy courses (e.g., corticosteroids and Benlysta plus mycophenolate, azathioprine, or cyclophosphamide; corticosteroids and Lupkynis plus mycophenolate) and will be using Lupkynis in combination with Benlysta plus mycophenolate (medical records required)
• AND
• • The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months