Furoscix (furosemide) — Highmark

Initial criteria

• age ≥ 18 years
• Furoscix is prescribed by or in consultation with a cardiologist
• Diagnosis of heart failure (ICD-10: I50) OR chronic kidney disease (ICD-10: N18) and/or nephrotic syndrome (ICD-10: N04)
• Prescriber attests that the member has experienced a previous episode of edema and was treated with a parenteral loop diuretic
• Member has been receiving an oral loop diuretic (e.g., furosemide, bumetanide, torsemide) as part of their medication regimen
• Prescriber attests that treatment with oral diuretics will resume as soon as practical after discontinuation of Furoscix

Reauthorization criteria

• Prescriber attests that the member has used Furoscix for a previous episode of edema due to chronic heart failure or chronic kidney disease (including nephrotic syndrome), had a positive clinical result, and avoided hospitalization
• Furoscix is prescribed by or in consultation with a cardiologist
• Diagnosis of heart failure (ICD-10: I50) OR chronic kidney disease (ICD-10: N18) and/or nephrotic syndrome (ICD-10: N04)
• Member has been receiving an oral loop diuretic (e.g., furosemide, bumetanide, torsemide) as part of their medication regimen
• Provider attests that treatment with oral diuretics will be discontinued until transitioned back to oral diuretic maintenance therapy

Approval duration

6 months