Clinical Policy: Nedosiran (Rivfloza)
Defines prior authorization, medical necessity, dosing, and renewal criteria for nedosiran (Rivfloza) for treatment of primary hyperoxaluria type 1 (PH1) for applicable Health Net lines of business.
Added HCPCS codes C9399 and J3490 to the policy.
Revised age and pediatric dosing criteria to include children up to 22 years and added requirement that request must be for a prefilled syringe unless the monthly dose is 128 mg.
Added medical geneticist to the list of specialist prescribers eligible to authorize therapy.
Added exclusion for concomitant use of Rivfloza with Oxlumo.
For Commercial line of business changed approval duration to 6 months or to the member's renewal date, whichever is longer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.