Korsuva (Medical)
Prior authorization and step-edit request form and medical coverage criteria for Korsuva (difelikefalin) solution for IV infusion (J0879) when used for pruritus in hemodialysis patients; includes initial and reauthorization clinical criteria, dosing quantity limits, and required documentation.
No material clinical/coverage changes in this update.
Coverage Summary
Scope: This policy covers medical benefit use of difelikefalin (Korsuva) Solution for IV infusion (HCPCS J0879) for treatment of moderate-to-severe chronic kidney disease-associated pruritus (CKD-aP) in adult patients receiving hemodialysis when the stated clinical criteria are met. Required documentation includes baseline WI-NRS, current dry weight and date weight obtained, and verification of prior therapy trials. Medicare Part B outpatient drug coverage references and applicable NCDs/LCDs are noted in the form and must be followed. Additional indications may be considered at the health plan's discretion.
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