tiopronin — Point32Health

Initial criteria

• Documented diagnosis of cystinuria
• Prescribed by or in consultation with a hepatologist, gastroenterologist, rheumatologist, or urologist
• Documentation of one (1) of the following: a. Patient has tried and failed ALL of the following conservative treatment measures for cystinuria: High fluid intake (urine output of at least three liters/day); sodium and protein dietary restrictions; and urinary alkalization with potassium citrate, potassium bicarbonate, or acetazolamide; OR b. Provider has indicated that the patient requires the use of the requested drug initially with the conservative measures because of very high cystine levels