Fabhalta (iptacopan) — Highmark
Complement 3 glomerulopathy (C3G)
Initial criteria
- age ≥ 18 years
- Diagnosis of complement 3 glomerulopathy (C3G) confirmed by biopsy
- Experiencing all of the following: urine protein-to-creatinine ratio (UPCR) ≥ 1.0 g/g AND estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2
- Therapeutic failure, contraindication, intolerance, or inadequate response to at least one of the following: systemic corticosteroids OR immunosuppressants OR mycophenolate mofetil
- Currently receiving the maximally tolerated dose or has experienced intolerance or contraindication to one of the following: ACE inhibitor OR ARB
Reauthorization criteria
- Member has experienced a reduction in UPCR from baseline
Approval duration
12 months