Thiola EC — Medica
severe homozygous cystinuria for the prevention of cystine kidney stone formation in adults and pediatric patients ≥ 20 kg who are not responsive to conservative measures (high fluid intake, alkali, and diet modification) alone
Preferred products
- generic tiopronin delayed-release tablets
- generic tiopronin tablets
- Venxxiva tablets
Initial criteria
- Patient meets the standard Prior Authorization Policy criteria for tiopronin products
- Patient has tried one Preferred Product (generic tiopronin delayed-release tablets, generic tiopronin tablets, or Venxxiva tablets)
Approval duration
per Metabolic Disorders – Tiopronin Products Prior Authorization Policy