Fabhalta (iptacopan) — Highmark
Primary immunoglobulin A nephropathy (IgAN)
Preferred products
- Filspari (sparsentan)
- Tarpeyo (budesonide)
Initial criteria
- age ≥ 18 years
- Diagnosis of IgAN confirmed by biopsy
- At risk for rapid disease progression evidenced by one of the following: urine protein-to-creatinine ratio (UPCR) ≥ 1.5 g/g OR proteinuria ≥ 1 g/day
- Therapeutic failure, contraindication, or intolerance to a maximally tolerated dose of one of the following: ACE inhibitor OR ARB
- Therapeutic failure, contraindication, or intolerance to both plan-preferred products: Filspari (sparsentan) AND Tarpeyo (budesonide)
Reauthorization criteria
- Member has experienced a reduction in UPCR or proteinuria from baseline
Approval duration
12 months