Tarpeyo (budesonide) delayed-release capsules — Highmark
primary immunoglobulin A nephropathy (IgAN) confirmed by biopsy
Preferred products
- methylprednisolone
- prednisone
Initial criteria
- age ≥ 18 years
- diagnosis of primary immunoglobulin A nephropathy (IgAN) confirmed by biopsy
- at risk for disease progression as evidenced by proteinuria ≥ 0.5 g/day
- EITHER concurrently taking one of the following: ACE inhibitor OR ARB OR Filspari OR has experienced contraindication or intolerance to all of the following: at least one ACE inhibitor AND at least one ARB AND Filspari
- has experienced therapeutic failure, contraindication, or intolerance to one plan-preferred systemic corticosteroid (e.g., methylprednisolone, prednisone)
Reauthorization criteria
- diagnosis of primary immunoglobulin A nephropathy (IgAN)
- EITHER concurrently taking one of the following: ACE inhibitor OR ARB OR Filspari OR has experienced contraindication or intolerance to all of the following: at least one ACE inhibitor AND at least one ARB AND Filspari
- has experienced therapeutic failure, contraindication, or intolerance to one plan-preferred systemic corticosteroid (e.g., methylprednisolone, prednisone)
- prescriber attests the member requires retreatment with Tarpeyo
Approval duration
10 months