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Lupkynis (voclosporin)United Healthcare

active lupus nephritis

Initial criteria

  • Diagnosis of active lupus nephritis
  • Prescribed in combination with a background immunosuppressive therapy regimen (e.g., mycophenolate mofetil and corticosteroids)
  • Patient is not receiving Lupkynis in combination with cyclophosphamide

Reauthorization criteria

  • Documentation of positive clinical response to Lupkynis therapy
  • Prescribed in combination with a background immunosuppressive therapy regimen (e.g., mycophenolate mofetil and corticosteroids)
  • Patient is not receiving Lupkynis in combination with cyclophosphamide

Approval duration

12 months