resmetirom — CareFirst (Caremark)
Noncirrhotic nonalcoholic steatohepatitis (NASH) [metabolic dysfunction–associated steatohepatitis (MASH)] with moderate to advanced liver fibrosis (stages F2 to F3)
Initial criteria
- Patient is an adult (age ≥ 18 years)
- Drug will be used in conjunction with diet and exercise
- Drug is prescribed by or in consultation with a gastroenterologist or hepatologist
- Moderate to advanced liver fibrosis (consistent with stages F2 to F3) at baseline has been confirmed by ONE of the following: non-invasive liver disease assessment (vibration-controlled transient elastography [VCTE], magnetic resonance elastography [MRE]) OR historical liver biopsy
Reauthorization criteria
- Patient is an adult (age ≥ 18 years)
- Drug will be used in conjunction with diet and exercise
- Patient has achieved or maintained a positive clinical response to therapy (e.g., improvement in liver function such as reduction in ALT, improvement in liver stiffness measure by VCTE or MRE)
Approval duration
12 months