Voquezna (vonoprazan) — United Healthcare
Non-Erosive Gastroesophageal Reflux Disease (GERD)
Preferred products
- omeprazole
- pantoprazole
- rabeprazole
Initial criteria
- Diagnosis of one of the following: (a) treatment or maintenance of erosive esophagitis OR (b) treatment of non-erosive gastroesophageal reflux disease (GERD)
- AND History of failure, contraindication, or intolerance to one of the following: omeprazole OR pantoprazole OR rabeprazole
Approval duration
9 months