Jesduvroq — Cigna

Initial criteria

• Patient has anemia associated with chronic kidney disease (CKD)
• Patient is not concurrently using erythropoiesis-stimulating agents (e.g., Procrit, Epogen, Retacrit, Aranesp, Mircera)
• Patient is not concurrently using Vafseo (vadadustat tablets)
• Jesduvroq is not prescribed to enhance athletic performance

Reauthorization criteria

• Patient continues to have anemia associated with chronic kidney disease (CKD)
• No concurrent use with erythropoiesis-stimulating agents or Vafseo (vadadustat)
• Jesduvroq is not used to enhance athletic performance

Approval duration

12 months