Vanrafia (atrasentan tablets) — Cigna

Primary Immunoglobulin A Nephropathy (IgAN)

Initial criteria

Patient age ≥ 18 years; AND
Diagnosis confirmed by biopsy; AND
Patient is at high risk of disease progression, defined by meeting BOTH of the following (a and b):
a) Patient meets ONE of the following [(1) or (2)]: (1) Proteinuria ≥ 0.5 g/day; OR (2) Urine protein-to-creatinine ratio ≥ 1.5 g/g; AND
b) Patient has received or is currently receiving the maximum or maximally tolerated dose of ONE of the following for ≥ 12 weeks prior to starting Vanrafia [(1) or (2)]: (1) Angiotensin converting enzyme inhibitor; OR (2) Angiotensin receptor blocker; AND
According to the provider, patient has received ≥ 3 months of optimized supportive care, including blood pressure management, lifestyle modification, and cardiovascular risk modification; AND
Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2; AND
Medication is prescribed by or on consultation with a nephrologist.

Patient age ≥ 18 years; AND
Diagnosis confirmed by biopsy; AND
According to the prescriber, patient has had a response to Vanrafia (e.g., reduction in urine protein-to-creatinine ratio from baseline, reduction in proteinuria from baseline); AND
Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2; AND
Medication is prescribed by or on consultation with a nephrologist.

9 months