Vafseo (vadadustat tablets - Akebia) — Cigna

Anemia in a patient with chronic kidney disease who is on dialysis

Initial criteria

Patient age ≥ 18 years; AND
Patient has been receiving dialysis for at least 3 consecutive months; AND
Patient meets ONE of the following (a or b):
a) Patient meets BOTH of the following (1 and 2):
(1) Patient is currently receiving an erythropoiesis-stimulating agent and transitioning to Vafseo; AND
(2) Patient has a hemoglobin level ≤ 12.0 g/dL; OR
b) Patient meets BOTH of the following (1 and 2):
(1) Patient is NOT currently receiving an erythropoiesis-stimulating agent; AND
(2) Patient has a baseline hemoglobin level < 11 g/dL; AND
Patient meets ONE of the following (a or b):
a) Patient is currently receiving iron therapy; OR
b) According to the prescriber, patient has adequate iron stores; AND
Medication is prescribed by or in consultation with a nephrologist.

Patient age ≥ 18 years; AND
Patient has been receiving dialysis for at least 3 consecutive months; AND
Patient has a hemoglobin level ≤ 12.0 g/dL; AND
Patient meets ONE of the following (a or b):
a) Patient is currently receiving iron therapy; OR
b) According to the prescriber, patient has adequate iron stores; AND
According to the prescriber, patient has experienced a response to therapy (e.g., increase or stabilization in hemoglobin levels or reduction/absence in red blood cell transfusions); AND
Medication is prescribed by or in consultation with a nephrologist.

initial 6 months, reauthorization 1 year