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avacopan — United Healthcare

severe active anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis

Initial criteria

  • Diagnosis of severe active ANCA-associated vasculitis
  • Disease is one of the following types: granulomatosis with polyangiitis (GPA) OR microscopic polyangiitis (MPA)
  • Used as adjunctive treatment in combination with standard therapy (e.g., prednisone, azathioprine, mycophenolate, methotrexate, rituximab, cyclophosphamide)

Reauthorization criteria

  • Patient does not show evidence of progressive disease while on Tavneos therapy
  • Used as adjunctive treatment in combination with standard therapy (e.g., prednisone, azathioprine, mycophenolate, methotrexate, rituximab, cyclophosphamide)

Approval duration

Initial: 6 months; Reauthorization: 12 months