Yorvipath (palopegteriparatide) — CareFirst (Caremark)

Initial criteria

• Member has hypoparathyroidism for six months or more
• Member is receiving vitamin D metabolite/analog therapy with calcitriol ≥ 0.5 mcg per day or alfacalcidol ≥ 1.0 mcg per day
• Member is receiving elemental calcium treatment ≥ 800 mg per day
• Serum 25-hydroxyvitamin D concentration is above the lower limit of normal laboratory range
• Albumin-corrected serum calcium level ≥ 7.8 mg/dL prior to initiating therapy
• Serum magnesium level is within normal laboratory limits
• Member does not have acute postsurgical hypoparathyroidism (within 6 months of surgery) with expected recovery

Reauthorization criteria

• Member is experiencing benefit from therapy as evidenced by maintenance or normalization of calcium levels compared to baseline

Approval duration

12 months