Velphoro (sucroferric oxyhydroxide) — Blue Cross Blue Shield of Kansas
Control of serum phosphorus or reduce serum phosphate in chronic kidney disease (CKD) or end stage renal disease (ESRD) patients on dialysis
Preferred products
- Ferric citrate 1 gm (210 mg ferric iron)
- calcium carbonate
- calcium acetate
- calcium with magnesium
- lanthanum carbonate
- sevelamer carbonate
- sevelamer HCl
Initial criteria
- Target Agent(s) will be approved when BOTH of the following are met:
- 1. The patient has ONE of the following:
- A. Has a medication history of use in the past 90 days to ONE prerequisite agent OR
- B. Has an intolerance or hypersensitivity to ONE prerequisite agent OR
- C. Has an FDA labeled contraindication to ALL prerequisite agents AND
- 2. The patient has ONE of the following: Preferred Agent(s) Ferric citrate 1 gm (210 mg ferric iron)