iptacopan hcl cap 200 MG — Blue Cross Blue Shield of Kansas
Primary immunoglobulin A nephropathy (IgAN)
Initial criteria
- Diagnosis of primary immunoglobulin A nephropathy (IgAN) confirmed by kidney biopsy
- Urine protein-to-creatinine ratio (UPCR) ≥ 0.44 g/g OR proteinuria ≥ 0.5 g/day
- eGFR ≥ 30 mL/min/1.73 m^2
- Tried and had inadequate response after at least a 3-month duration of therapy with a maximally tolerated ACE inhibitor or ARB, OR intolerance or hypersensitivity to an ACEi or ARB, OR an FDA-labeled contraindication to ALL ACEi and ARB
- Prescriber is a specialist in the area of the patient’s diagnosis (e.g., nephrologist) or has consulted with a specialist
- The agent will NOT be used in combination with Empaveli (pegcetacoplan), Soliris (eculizumab), Bkemv (eculizumab-aeeb), Epysqli (eculizumab-aagh), Ultomiris (ravulizumab-cwvz), or Piasky (crovalimab-akkz)
- The patient does NOT have any FDA-labeled contraindications to Fabhalta
Approval duration
9 months