Vafseo (vadadustat) — CareFirst (Caremark)

Initial criteria

• Member has been receiving dialysis for at least three months
• Pretreatment hemoglobin level ≤ 11 g/dL
• Member assessed for iron deficiency anemia and has adequate iron stores (serum transferrin saturation [TSAT] ≥ 20% within the prior 3 months) or is receiving iron therapy before starting Vafseo
• Vafseo is not used concomitantly with erythropoiesis-stimulating agents

Reauthorization criteria

• Member assessed for iron deficiency anemia and has adequate iron stores (TSAT ≥ 20% within the prior 3 months) or is receiving iron therapy before continuation
• Vafseo is not used concomitantly with erythropoiesis-stimulating agents
• Member has shown a rise in hemoglobin ≥ 1 g/dL after at least 12 weeks of Vafseo treatment, OR
• If member has been on therapy for less than 12 weeks and has not yet responded with a rise in hemoglobin ≥ 1 g/dL, authorization may be granted for up to 12 weeks to allow time to demonstrate response
• Current hemoglobin level < 12 g/dL

Approval duration

12 weeks