Jesduvroq — CareFirst (Caremark)

Initial criteria

• age ≥ 18 years
• member has been receiving dialysis for at least four months
• pretreatment hemoglobin level ≤ 11 g/dL
• member has been assessed for iron deficiency anemia and has adequate iron stores (serum transferrin saturation [TSAT] ≥ 20% within the prior 3 months) or is receiving iron therapy
• Jesduvroq is not used concomitantly with erythropoiesis stimulating agents

Reauthorization criteria

• member has been assessed for iron deficiency anemia and has adequate iron stores (TSAT ≥ 20% within the prior 3 months) or is receiving iron therapy
• Jesduvroq is not used concomitantly with erythropoiesis stimulating agents
• after at least 12 weeks of Jesduvroq therapy member shows a hemoglobin rise ≥ 1 g/dL; OR if less than 12 weeks and not yet responded, may receive up to 12 more weeks to allow for response
• current hemoglobin < 12 g/dL

Approval duration

12 weeks