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Prevymis (letermovir) oral pellets — Highmark

Prophylaxis of cytomegalovirus (CMV) infection or disease in cytomegalovirus (CMV)-seropositive recipients [R+] of an allogeneic hematopoietic stem cell transplant (HSCT)

Initial criteria

  • age ≥ 6 months and weight ≥ 6 kg for HSCT recipients who are CMV-seropositive [R+]
  • age ≥ 12 years and weight ≥ 40 kg for kidney transplant recipients at high risk (D+/R-)
  • Prevymis oral pellets are being used for prophylaxis of CMV infection or disease
  • Member is unable to swallow tablets OR unable to use Prevymis tablets due to body weight dosing limitations

Approval duration

up to 7 months