Yorvipath (palopegteriparatide) — Point32Health

Initial criteria

• Documented diagnosis of chronic hypoparathyroidism defined as ≥ 6 months
• Prescribed by or in consultation with an endocrinologist
• Documentation of ONE of the following: (a) prescribed as adjunct to calcium supplements and active forms of vitamin D OR (b) contraindication to calcium supplements and active forms of vitamin D
• Provider attestation that disease cannot be adequately controlled on conventional therapy (calcium supplements and active vitamin D) alone
• Documentation of ALL of the following from lab results within the last 30 days: (a) serum 25-hydroxyvitamin D concentration within normal laboratory limits (30–100 ng/mL); (b) albumin-corrected serum calcium ≥ 7.8 mg/dL; (c) serum magnesium within normal laboratory limits (1.7–2.2 mg/dL)
• Patient age ≥ 18 years

Reauthorization criteria

• Documented diagnosis of chronic hypoparathyroidism defined as ≥ 6 months
• Prescribed by or in consultation with an endocrinologist
• Patient age ≥ 18 years
• Documentation that the patient has experienced a therapeutic response defined as maintained or normalized calcium levels compared to baseline

Approval duration

initial 6 months; reauthorization 12 months