Cuvrior (trientine tetrahydrochloride) — United Healthcare

Initial criteria

• Diagnosis of Wilson’s disease
• Patient is de-coppered (serum non-ceruloplasmin copper [NCC] level ≥ 25 and ≤ 150 mcg/L)
• Patient is tolerant to penicillamine
• Patient will discontinue penicillamine before starting therapy with Cuvrior

Reauthorization criteria

• Documentation of positive clinical response to Cuvrior therapy

Approval duration

12 months