Lupkynis (voclosporin) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of lupus nephritis (ICD-10: M32.14), classified as active disease
• EITHER diagnosis confirmed by a renal biopsy OR contraindication to renal biopsy AND laboratory findings specific to lupus nephritis (for example, elevated serum creatinine, abnormal urine analysis [proteinuria ≥ 500 mg/day, hypoalbuminemia, hematuria, casts], decreased eGFR)
• member will receive background immunosuppressive therapy with ALL of the following: corticosteroid (for example, prednisone, methylprednisolone) AND mycophenolic acid analog (MPAA) (for example, mycophenolate mofetil)

Reauthorization criteria

• prescriber attests member demonstrates therapeutic response defined as EITHER disease stability OR disease improvement
• member will receive background immunosuppressive therapy with ALL of the following: corticosteroid (for example, prednisone, methylprednisolone) AND ONE of the following: mycophenolic acid analog (MPAA) (for example, mycophenolate mofetil) OR azathioprine

Approval duration

initial: 24 weeks; reauthorization: 12 months