Skip to content
The Policy VaultThe Policy Vault

RezdiffraMedica

Non-Alcoholic Steatohepatitis (NASH)

Initial criteria

  • age ≥ 18 years
  • Diagnosis of MASH/NASH confirmed by ONE of the following: (a) Liver biopsy performed within 3 years showing NAFLD activity score ≥ 4 with a score of ≥ 1 in steatosis, ballooning, and lobular inflammation; OR (b) Imaging exam (elastography, computed tomography, or magnetic resonance imaging) performed within 6 months prior to treatment
  • Patient has stage F2 fibrosis OR stage F3 fibrosis
  • Patient has THREE or more metabolic risk factors managed according to standard of care (central obesity, hypertriglyceridemia, reduced high-density lipoprotein cholesterol, hypertension, elevated fasting plasma glucose indicative of diabetes or pre-diabetes)
  • Alcohol consumption is < 20 grams/day for female patients OR < 30 grams/day for male patients
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Reauthorization criteria

  • Patient has completed ≥ 1 year of therapy with Rezdiffra
  • According to the prescriber, patient has not had worsening of fibrosis or MASH/NASH
  • Patient has not progressed to stage F4 (cirrhosis)
  • Metabolic risk factors are managed according to standard of care
  • Alcohol consumption is < 20 grams/day for female patients OR < 30 grams/day for male patients
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Approval duration

1 year