Empaveli — Medica

Initial criteria

• Patient is ≥ 12 years of age
• Diagnosis has been confirmed by biopsy
• Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
• Patient has been on stable doses of at least ONE of the following for ≥ 12 weeks prior to starting Empaveli: (a) Angiotensin converting enzyme inhibitor; OR (b) Angiotensin receptor blocker; OR (c) Sodium-glucose transporter-2 inhibitor
• The medication is prescribed by or in consultation with a nephrologist

Reauthorization criteria

• Patient is ≥ 12 years of age
• Diagnosis has been confirmed by biopsy
• According to the prescriber, patient has had a response to Empaveli (examples of a response include reduction in urine-to-creatinine ratio or reduction in proteinuria from baseline)
• Patient has an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
• The medication is prescribed by or in consultation with a nephrologist

Approval duration

initial 6 months, renewal 1 year