Attruby (acoramidis tablets – Bridgebio) — Cigna

Initial criteria

• Patient age ≥ 18 years; AND
• Diagnosis confirmed by ONE of the following (i, ii, or iii): i) technetium pyrophosphate scan (nuclear scintigraphy); OR ii) tissue biopsy with confirmatory transthyretin (TTR) amyloid typing by mass spectrometry, immunoelectron microscopy, or immunohistochemistry; OR iii) genetic testing identifying a transthyretin (TTR) pathogenic variant; AND
• Diagnostic cardiac imaging demonstrates cardiac involvement; AND
• Patient has heart failure but does not have New York Heart Association class IV disease; AND
• Medication is prescribed by or in consultation with a cardiologist or a physician who specializes in the treatment of amyloidosis.
• Medication is NOT used concurrently with other medications indicated for treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis or transthyretin-mediated amyloidosis-cardiomyopathy (e.g., Amvuttra [vutrisiran], Onpattro [patisiran], Tegsedi [inotersen], Wainua [eplontersen], or tafamidis products).

Approval duration

1 year