Lokelma (sodium zirconium cyclosilicate) — United Healthcare

Initial criteria

• Diagnosis of non-life threatening hyperkalemia
• Where clinically appropriate, loop or thiazide diuretic therapy for potassium removal has failed
• Patient follows a low potassium diet (less than or equal to 3 grams per day)

Reauthorization criteria

• Patient has a positive clinical response to Lokelma or Veltassa therapy and continues to require treatment for hyperkalemia
• Patient follows a low potassium diet (less than or equal to 3 grams per day)

Approval duration

12 months