Rivfloza (nedosiran) — United Healthcare

Initial criteria

• EITHER:
• ALL of the following:
• - Patient has been established on therapy with Rivfloza under an active UnitedHealthcare medical benefit prior authorization for the treatment of primary hyperoxaluria type 1 (PH1) AND
• - Documentation of positive clinical response to Rivfloza AND
• - Patient is not receiving Rivfloza in combination with Oxlumo (lumasiran)
• OR
• ALL of the following:
• - Diagnosis of primary hyperoxaluria type 1 (PH1) AND
• - age ≥ 2 years AND
• - Patient has relatively preserved kidney function (e.g., eGFR ≥ 30 mL/min/1.73 m2) AND
• - Patient is not receiving Rivfloza in combination with Oxlumo (lumasiran)

Reauthorization criteria

• ALL of the following:
• - Documentation of positive clinical response to Rivfloza therapy AND
• - Patient is not receiving Rivfloza in combination with Oxlumo (lumasiran)

Approval duration

12 months