Tavneos (avacopan) — CareFirst (Caremark)
Severe active anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]) in combination with standard therapy including glucocorticoids
Initial criteria
- Tavneos will be used in combination with standard therapy (e.g., rituximab, cyclophosphamide, methotrexate, azathioprine, mycophenolate mofetil)
- Member has a history of testing positive for anti-proteinase-3 (anti-PR3) or anti-myeloperoxidase (anti-MPO) antibody
- Documentation of pretreatment objective assessment of the most impactful aspects of the member’s ANCA-associated vasculitis (e.g., renal, pulmonary, neurologic)
Reauthorization criteria
- Member has achieved or maintained a positive clinical response as evidenced by stabilization or improvement in the most impactful aspects of the member’s ANCA-associated vasculitis (e.g., renal, pulmonary, neurologic)
Approval duration
12 months