Xphozah (tenapanor) — United Healthcare
Chronic kidney disease (CKD) on dialysis with hyperphosphatemia
Preferred products
- calcium acetate (generic PhosLo)
- lanthanum carbonate (generic Fosenrol)
- sevelamer carbonate (generic Renvela)
- Velphoro (sucroferric oxyhydroxide)
Initial criteria
- Diagnosis of chronic kidney disease (CKD)
- Patient is receiving dialysis
- Serum phosphorus > 6.5 mg/dL
- Patient has had an inadequate response to a maximally tolerated dose of two of the following phosphate binders: calcium acetate (generic PhosLo), lanthanum carbonate (generic Fosenrol), sevelamer carbonate (generic Renvela), Velphoro (sucroferric oxyhydroxide)
- Xphozah will be used as add-on therapy
- Prescribed by or in consultation with a nephrologist
Reauthorization criteria
- Documentation of positive clinical response to Xphozah therapy (e.g., reduction of serum phosphorus towards the normal range 3.5–5.5 mg/dL)
- Prescribed by or in consultation with a nephrologist
Approval duration
12 months