Ferriprox (deferiprone tablets and oral solution) — Cigna

Initial criteria

• Prescriber is a hematologist OR therapy is prescribed in consultation with a hematologist.
• For transfusion-related iron overload due to thalassemia syndromes: prior to starting chelating therapy, serum ferritin level > 1,000 mcg/L [documentation required].
• For transfusion-related iron overload due to sickle cell disease or other anemias: prior to starting chelating therapy, serum ferritin level > 1,000 mcg/L [documentation required].

Reauthorization criteria

• Patient is currently receiving deferiprone therapy AND is benefiting from therapy according to the prescriber (e.g., reduction in serum ferritin levels, stable disease, or reduced organ iron load).

Approval duration

1 year