Rezdiffra — Cigna
Metabolic Dysfunction–Associated Steatohepatitis (MASH)/Non-Alcoholic Steatohepatitis (NASH)
Initial criteria
- Diagnosis of MASH/NASH is confirmed AND
- Patient has moderate or advanced fibrosis (stage F2 or F3) [documentation required] AND
- Patient has had a liver biopsy within the 3 years preceding treatment with Rezdiffra [documentation required] AND
- Liver biopsy shows non-alcoholic fatty liver disease activity score ≥ 4 with a score ≥ 1 in ALL of the following [documentation required]: steatosis, ballooning, and lobular inflammation AND
- Imaging exam (elastography, computed tomography, or magnetic resonance imaging) was performed within the 6 months preceding treatment with Rezdiffra [documentation required]
Reauthorization criteria
- Patient has completed ≥ 1 year of therapy with Rezdiffra AND
- According to the prescriber, patient has not had worsening of fibrosis or MASH/NASH AND
- Patient has not progressed to stage F4 (cirrhosis)