Livdelzi (seladelpar) — United Healthcare
primary biliary cholangitis
Preferred products
- ursodeoxycholic acid (Urso, ursodiol)
Initial criteria
- Diagnosis of primary biliary cholangitis
- AND Patient does not have decompensated cirrhosis
- AND One of the following:
- (1) BOTH of the following: (a) Used in combination with ursodeoxycholic acid (e.g., Urso, ursodiol) AND (b) Patient has not achieved an adequate response to an appropriate dosage of ursodeoxycholic acid after at least 12 consecutive months of therapy
- OR (2) History of contraindication or intolerance to ursodeoxycholic acid (e.g., Urso, ursodiol)
Reauthorization criteria
- Documentation of positive clinical response to Livdelzi therapy
Approval duration
12 months