Filspari (sparsentan tablets − Travere) — Cigna

Primary Immunoglobulin A Nephropathy (IgAN)

Initial criteria

Patient is age ≥ 18 years; AND
Diagnosis has been confirmed by biopsy; AND
Patient is at high risk of disease progression, defined by meeting BOTH of the following:
a) Patient meets ONE of the following: (1) Proteinuria ≥ 0.5 g/day; OR (2) Urine protein-to-creatinine ratio ≥ 0.8 g/g; AND
b) Patient has received the maximum or maximally tolerated dose of ONE of the following for ≥ 12 weeks prior to starting Filspari: (1) Angiotensin converting enzyme inhibitor; OR (2) Angiotensin receptor blocker; AND
Patient has received ≥ 3 months of optimized supportive care, including blood pressure management, lifestyle modification, and cardiovascular risk modification, according to the prescriber; AND
Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2; AND
The medication will not be used in combination with any renin-angiotensin-aldosterone antagonists (e.g., angiotensin converting enzyme inhibitors or angiotensin receptor blockers), endothelin receptor antagonists, or aliskiren; AND
The medication is prescribed by or on consultation with a nephrologist.

Patient is age ≥ 18 years; AND
Diagnosis has been confirmed by biopsy; AND
Patient has had a response to Filspari, according to the prescriber (e.g., reduction in urine protein-to-creatinine ratio from baseline, reduction in proteinuria from baseline); AND
Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2; AND
The medication is not being used in combination with any renin-angiotensin-aldosterone antagonists (e.g., angiotensin converting enzyme inhibitors or angiotensin receptor blockers), endothelin receptor antagonists, or aliskiren; AND
The medication is prescribed by or on consultation with a nephrologist.

1 year