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The Policy VaultThe Policy Vault

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