sparsentan — CareFirst (Caremark)
Primary immunoglobulin A nephropathy (IgAN)
Initial criteria
- Diagnosis of primary immunoglobulin A nephropathy (IgAN) confirmed by kidney biopsy
- Either proteinuria ≥ 1 g/day OR urine protein-to-creatinine ratio (UPCR) ≥ 0.8 g/g
- Member has received a stable dose of maximally tolerated renin-angiotensin system (RAS) inhibitor therapy (e.g., angiotensin converting enzyme inhibitor [ACEI] or angiotensin II receptor blocker [ARB]) for at least 3 months prior to initiation of therapy, OR member has an intolerance or contraindication to RAS inhibitors
Reauthorization criteria
- Member is currently receiving Filspari and experiencing benefit from therapy as evidenced by decreased levels of proteinuria from baseline OR decrease in UPCR from baseline
Approval duration
12 months