Voquezna — Highmark
Healing of erosive esophagitis and relief of heartburn associated with erosive esophagitis
Preferred products
- omeprazole
- pantoprazole
Initial criteria
- age ≥ 18 years
- using Voquezna for healing of erosive esophagitis (ICD-10: K22.1) and for relief of heartburn associated with erosive esophagitis
- experienced therapeutic failure, contraindication, or intolerance to all of the following plan-preferred products: omeprazole AND pantoprazole
Reauthorization criteria
- age ≥ 18 years
- using Voquezna to maintain healing of erosive esophagitis (ICD-10: K22.1) and for relief of heartburn associated with erosive esophagitis
- responded to an initial treatment course and continues to have erosive esophagitis that requires treatment for maintenance
Approval duration
initial: 8 weeks; reauthorization: 6 months