Thiola EC (tiopronin delayed-release tablets – Mission Pharmacal, generic) — Cigna

Initial criteria

• Patient weighs ≥ 20 kg; AND
• Diagnosis of cystinuria has been confirmed based on laboratory testing (e.g., urinary cystine crystals present on microscopy, quantitative urine cystine assay); AND
• According to the prescriber, the patient has had an inadequate response to high fluid intake, dietary modification, and urinary alkalization; AND
• The medication is prescribed by or in consultation with a nephrologist, urologist, or physician who specializes in the treatment of cystinuria.

Approval duration

1 year