mitapivat — CareFirst (Caremark)

Initial criteria

• Member has hemolytic anemia with pyruvate kinase (PK) deficiency
• Member age ≥ 18 years
• Member meets at least one of the following: deficiency of PK enzyme activity OR presence of at least 2 mutant alleles in the PKLR gene, of which at least 1 is a missense mutation
• Member meets at least one of the following: history of a minimum of 6 blood transfusion episodes in the past 52 weeks OR hemoglobin (Hgb) concentration ≤ 10.0 g/dL

Reauthorization criteria

• Member continues to have hemolytic anemia with pyruvate kinase (PK) deficiency
• Member has achieved or maintained a positive clinical response to therapy (e.g., improvement in hemoglobin levels, reduction in blood transfusions)

Approval duration

Initial: 7 months; Reauthorization: 12 months