Lupkynis (voclosporin) — CareFirst (Caremark)

Initial criteria

• Prior to initiating therapy, the member is positive for autoantibodies relevant to systemic lupus erythematosus (e.g., ANA, anti-ds DNA, anti-Sm, antiphospholipid antibodies, complement proteins) or lupus nephritis was confirmed on kidney biopsy.
• Member has clinically active lupus renal disease and is receiving background therapy with mycophenolate mofetil (MMF) with corticosteroids.
• Member must have an eGFR > 45 ml/min per 1.73 m2.

Reauthorization criteria

• Authorization may be granted for continued treatment in members requesting reauthorization who achieve or maintain a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition.

Approval duration

12 months