Fabhalta — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Paroxysmal nocturnal hemoglobinuria diagnosis was confirmed by peripheral blood flow cytometry results showing the absence or deficiency of glycosylphosphatidylinositol-anchored proteins on at least two cell lineages
• The medication is prescribed by or in consultation with a hematologist

Reauthorization criteria

• Patient is age ≥ 18 years
• According to the prescriber, patient is continuing to derive benefit from Fabhalta
• The medication is prescribed by or in consultation with a hematologist

Approval duration

initial: 6 months; reauth: 1 year