Gattex (teduglutide subcutaneous injection – Takeda) — Cigna

Initial criteria

• Patient age ≥ 1 year; AND
• Patient meets ONE of the following (a or b): a) patient is currently receiving parenteral nutrition on 3 or more days per week; OR b) according to the prescriber, the patient is unable to receive adequate total parenteral nutrition (TPN) required for caloric needs; AND
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has already received at least 6 months of therapy with Gattex; AND
• According to the prescriber, patient has experienced at least a 20% decrease from baseline in weekly volume of parenteral nutrition; AND
• Medication is prescribed by or in consultation with a gastroenterologist

Approval duration

initial 6 months; reauth 1 year