Lupkynis (voclosporin capsules – Aurinia) — Cigna

Lupus nephritis

Initial criteria

Patient is age ≥ 18 years; AND
Diagnosis of lupus nephritis has been confirmed on biopsy (e.g., WHO class III, IV, or V lupus nephritis); AND
The medication is being used concurrently with an immunosuppressive regimen (e.g., mycophenolate mofetil or azathioprine with a systemic corticosteroid); AND
Patient has an estimated glomerular filtration rate (eGFR) > 45 mL/min/m2; AND
The medication is prescribed by or in consultation with a nephrologist or rheumatologist.

Patient is age ≥ 18 years; AND
The medication is being used concurrently with an immunosuppressive regimen (e.g., mycophenolate mofetil or azathioprine with a systemic corticosteroid); AND
Patient has responded to Lupkynis as determined by the prescriber (e.g., improvement in organ dysfunction, reduction in flares, reduction in corticosteroid dose, decrease of anti-double stranded DNA titer, and improvement in complement levels [C3, C4]); AND
The medication is prescribed by or in consultation with a nephrologist or rheumatologist.

initial 6 months; reauth 1 year