Livtencity (maribavir tablets) — Cigna
Cytomegalovirus (CMV) infection – treatment in post-transplant patients refractory or intolerant to standard therapy
Initial criteria
- Patient age ≥ 12 years AND weight ≥ 35 kg; AND
- Patient is post-transplant (hematopoietic stem cell or solid organ transplant); AND
- Patient has cytomegalovirus infection/disease that is refractory to treatment with at least one of the following: cidofovir, foscarnet, ganciclovir, or valganciclovir OR patient has significant intolerance to ganciclovir or valganciclovir; AND
- Livtencity is not prescribed in conjunction with ganciclovir or valganciclovir; AND
- Medication is prescribed by or in consultation with a hematologist, infectious diseases specialist, oncologist, or a physician affiliated with a transplant center
Reauthorization criteria
- According to the prescriber, patient has responded to Livtencity as demonstrated by cytomegalovirus polymerase chain DNA laboratory results within the past 4 weeks demonstrating improvement in cytomegalovirus levels
Approval duration
2 months