Tavneos (avacopan) — Highmark

Initial criteria

• age ≥ 18 years
• Diagnosis of one of the following: GPA (ICD-10: M31.3) classified as severe active disease OR MPA (ICD-10: M31.7) classified as severe active disease
• Prescriber attests to a positive test for anti-PR3 OR positive test for anti-MPO
• Member will receive concomitant standard of care with immunosuppressants (e.g., rituximab, cyclophosphamide, azathioprine, mycophenolate mofetil) for the treatment of active severe GPA or MPA

Reauthorization criteria

• Prescriber attests that the member demonstrates therapeutic response, defined as disease stability OR disease improvement
• Member will continue to receive concomitant standard of care with immunosuppressants (e.g., rituximab, cyclophosphamide, azathioprine, mycophenolate mofetil) for the treatment of GPA or MPA

Approval duration

initial: 6 months; reauthorization: 12 months