Veltassa (patiromer) — Highmark
chronic hyperkalemia
Initial criteria
- AND criteria (A through D) must be met:
- A. The member meets one of the following:
- 1. If the request is for Veltassa, age ≥ 12 years.
- 2. If the request is for Lokelma, age ≥ 18 years.
- B. The member has a diagnosis of chronic hyperkalemia (ICD-10: E87.5).
- C. Serum potassium level between 5.1 and 7.4 mmol/L on at least two screenings (lab results must be provided).
- D. Documentation that modification of medications (e.g., ACE inhibitors, ARBs, aldosterone antagonist, etc.) to reduce potassium levels, if appropriate, was not successful.
Reauthorization criteria
- A. Documentation of a reduction in serum potassium levels following Veltassa or Lokelma administration.
- B. The member continues to require treatment for hyperkalemia.
Approval duration
initial: up to 6 months (12 months for Delaware Commercial fully-insured and ACA members); reauthorization: up to 12 months