Voquezna — Highmark
Relief of heartburn associated with non-erosive gastroesophageal reflux disease (NERD)
Preferred products
- omeprazole
- pantoprazole
Initial criteria
- age ≥ 18 years
- using Voquezna for relief of heartburn associated with non-erosive gastroesophageal reflux disease (ICD-10: K21.9)
- experienced therapeutic failure, contraindication, or intolerance to all of the following plan-preferred products: omeprazole AND pantoprazole
Reauthorization criteria
- continues to have a diagnosis of non-erosive gastroesophageal reflux disease which requires additional Voquezna therapy
- prescriber attests the member has experienced symptom improvement or control during the initial 4-week treatment course
- total treatment duration with Voquezna will not exceed 24 weeks in the past 365 days
Approval duration
initial: 4 weeks; reauthorization: 20 weeks