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The Policy VaultThe Policy Vault

tenapanorUnited Healthcare

To reduce serum phosphorus in adults with chronic kidney disease (CKD) on dialysis as add-on therapy in patients who have an inadequate response to phosphate binders or who are intolerant of any dose of phosphate binder therapy

Preferred products

  • calcium acetate
  • sevelamer
  • lanthanum
  • Velphoro (sucroferric oxyhydroxide)

Initial criteria

  • Diagnosis of chronic kidney disease (CKD)
  • Patient is receiving dialysis
  • Xphozah will be used as add-on therapy to reduce serum phosphorus
  • Patient has had an inadequate response to phosphate binder therapy [e.g., calcium acetate, sevelamer, lanthanum, Velphoro (sucroferric oxyhydroxide)] OR Patient is intolerant to any dose of phosphate binder therapy

Reauthorization criteria

  • Documentation of positive clinical response to Xphozah therapy

Approval duration

12 months