Tavneos (avacopan capsules - ChemoCentryx) — Cigna

Initial criteria

• Patient age ≥ 18 years; AND
• Patient has granulomatosis with polyangiitis or microscopic polyangiitis; AND
• Patient has active disease (newly diagnosed or relapsed, not in remission); AND
• Patient is positive for proteinase 3 antibodies, myeloperoxidase antibodies, or anti-neutrophil cytoplasmic autoantibody (ANCA); AND
• Patient is using Tavneos in combination with at least one nonglucocorticoid immunosuppressant for ANCA-associated vasculitis (e.g., rituximab, cyclophosphamide, methotrexate, azathioprine, mycophenolate mofetil); AND
• Medication is prescribed by or in consultation with a rheumatologist, nephrologist, pulmonologist, or immunologist.

Reauthorization criteria

• Patient age ≥ 18 years; AND
• Patient has been established on Tavneos for at least 6 months; AND
• Patient meets at least ONE of the following: (a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (e.g., improvement in estimated glomerular filtration rate, decrease in urinary albumin creatinine ratio, improvement in Birmingham Vasculitis Activity Score [BVAS]); OR (b) Compared with baseline, patient experienced improvement in at least one symptom (joint pain, ulcers, myalgia, persistent cough, skin rash, abdominal pain) or improvement in function or activities of daily living.

Approval duration

initial: 6 months; reauth: 1 year