Filspari (sparsentan) — Point32Health
primary immunoglobulin A nephropathy (IgAN) in adults who are at risk for disease progression
Initial criteria
- Documented diagnosis of immunoglobulin A nephropathy confirmed by kidney biopsy
- Documented urine protein-to-creatinine ratio (UPCR) of at least 1.5 g/g OR proteinuria ≥ 1 g/day
- Documented estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
- Prescribed by or in consultation with a nephrologist
- Documentation that the patient has not developed end stage renal disease by requiring either dialysis or kidney transplant
- Documentation that the member has received at least 3 months of therapy with an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) at up to maximally indicated doses, unless contraindicated or not tolerated
- Documentation that the member has received or is currently receiving at least 3 months of therapy with a sodium-glucose cotransporter-2 inhibitor (SGLT2i), unless contraindicated or not tolerated
- Documentation that the member has received optimized supportive care for at least 3 months, including blood pressure management, lifestyle modification, and cardiovascular risk modification
- Filspari is not used in combination with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), endothelin receptor antagonist (ERA), or aliskiren
Reauthorization criteria
- Documented diagnosis of immunoglobulin A nephropathy confirmed by kidney biopsy
- Prescribed by or in consultation with a nephrologist
- Documentation of a positive clinical response as evidenced by a reduction in proteinuria
- Documentation that the patient has not developed end stage renal disease by requiring either dialysis or kidney transplant
Approval duration
initial 9 months; reauth 12 months