Livtencity (maribavir) — Highmark
post-transplant cytomegalovirus (CMV) infection or disease that is refractory to treatment
Initial criteria
- age ≥ 12 years
- member weighs at least 35 kg
- documentation of refractory CMV infection or disease as evidenced by antigenemia or PCR test
- member is a recipient of hematopoietic stem cell transplant (HSCT) OR solid organ transplant (SOT)
- therapeutic failure to at least one of the following agents: ganciclovir, valganciclovir, cidofovir, foscarnet
Reauthorization criteria
- prescriber attests that member has previously experienced reduction in CMV DNA level
- member is experiencing one of the following: new onset symptomatic CMV infection OR virologic relapse without treatment-emergent maribavir resistance OR requiring continued antiviral treatment to achieve virologic clearance
Approval duration
initial: up to 8 weeks; reauthorization: up to 16 weeks (total cumulative 24 weeks)