Nocdurna (desmopressin acetate) — United Healthcare

Initial criteria

• Diagnosis of nocturia due to nocturnal polyuria (nighttime urine production exceeds one-third of 24-hour urine production)
• Patient wakes at least twice per night on a recurring basis to void
• Documented serum sodium level is currently within normal limits and has been within normal limits over the previous 6 months
• Patient has been evaluated for other medical causes and has either not responded to, tolerated, or has a contraindication to treatments for identifiable medical causes (e.g., overactive bladder, benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), elevated post-void residual urine, and heart failure)
• Prescriber attests that the risks have been assessed and benefits outweigh the risks

Reauthorization criteria

• Documentation of positive clinical response to Nocdurna therapy
• Patient has routine monitoring for serum sodium levels
• Prescriber attests that the risks of hyponatremia have been assessed and benefits outweigh the risks

Approval duration

12 months