inotersen — United Healthcare

Initial criteria

• Diagnosis of hATTR amyloidosis with polyneuropathy
• Patient has a pathogenic TTR mutation (e.g., V30M)
• Patient is not receiving Tegsedi in combination with either of the following: (a) Oligonucleotide agents [e.g., Onpattro (patisiran), Amvuttra (vutrisiran)] (b) Tafamidis (e.g., Vyndaqel, Vyndamax)

Reauthorization criteria

• Documentation of positive clinical response to Tegsedi therapy
• Patient is not receiving Tegsedi in combination with either of the following: (a) Oligonucleotide agents [e.g., Onpattro (patisiran), Amvuttra (vutrisiran)] (b) Tafamidis (e.g., Vyndaqel, Vyndamax)

Approval duration

12 months