Fabhalta (iptacopan capsules – Novartis) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Diagnosis has been confirmed by biopsy
• Urine protein-to-creatinine ratio ≥ 1.0 g/g
• Estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
• Patient has received the maximum or maximally tolerated dose of at least ONE of the following for ≥ 12 weeks prior to starting Fabhalta: (a) angiotensin converting enzyme inhibitor OR (b) angiotensin receptor blocker
• Medication is prescribed by or in consultation with a nephrologist

Reauthorization criteria

• Patient age ≥ 18 years
• Diagnosis has been confirmed by biopsy
• According to the prescriber, patient has had a response to Fabhalta

Approval duration

initial: 6 months; reauth: 1 year