Vanrafia (atrasentan) — Point32Health

Initial criteria

• Documented diagnosis of immunoglobulin A nephropathy confirmed by kidney biopsy
• Documented urine protein-to-creatinine ratio (UPCR) ≥ 1.5 g/g OR proteinuria ≥ 1 g/day
• Documented estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2
• Prescribed by or in consultation with a nephrologist
• Documentation the patient has not developed end stage renal disease by requiring either dialysis or a kidney transplant
• Documentation that the member has received or is currently receiving 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

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 the patient has not developed end stage renal disease by requiring either dialysis or a kidney transplant

Approval duration

initial 9 months; reauth 12 months