Xphozah (tenapanor) — Highmark
To reduce serum phosphorus in adults with chronic kidney disease (CKD) on dialysis as add-on therapy in patients who have an inadequate response to phosphate binders or who are intolerant of any dose of phosphate binder therapy
Preferred products
- Calcium acetate
- Sevelamer carbonate tablet
Initial criteria
- age ≥ 18 years
- Diagnosis of CKD and on dialysis (ICD-10: Z99.2)
- AND member meets one of the following:
- 1. Using Xphozah as add-on therapy and has had inadequate response to all of the following plan-preferred phosphate binders:
- - Calcium acetate
- - Sevelamer carbonate tablet
- OR
- 2. Experienced intolerance or contraindication to all of the following plan-preferred phosphate binders:
- - Calcium acetate
- - Sevelamer carbonate tablet
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months