Empaveli (pegcetacoplan) — Highmark

Reauthorization criteria

• Prescriber attests member has experienced a positive clinical response defined as one of the following: achieved hemoglobin stabilization or increase from baseline OR decrease from baseline in number of transfusions OR decrease from baseline in LDH levels or reduction of hemolysis
• Prescriber attests Empaveli will not be used in combination with another complement inhibitor for PNH (e.g., Soliris, Ultomiris)

Approval duration

12 months