Krintafel (tafenoquine) prior authorization for P. vivax relapse prevention
Customize your policy alerts
Sign up for all Mass General Brigham Health Plan policy alerts
Know when Mass General Brigham Health Plan releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs prior authorization requirements for Krintafel (tafenoquine) under the Mass General Brigham Health Plan pharmacy benefit for commercial/exchange members, specifying eligibility, testing, and quantity/duration limits.
Removed documentation requirement and clarified approval length will be five days.
Coverage Criteria for Krintafel (tafenoquine)
Initial Authorization Criteria
Covered when ALL of the following are met:
These three conditions are required for approval.
This agent is not indicated for the treatment of acute P. vivax malaria. Requests for Krintafel (tafenoquine) intended to treat an active P. vivax infection should be denied or redirected to appropriate acute antimalarial therapy per clinical guidelines.
Coding and Testing Requirements
| No codes listed |
Provider Actions, Documentation, and Denial Triggers
Prior authorization required for Krintafel (pharmacy benefit)
Prior authorization is required for Krintafel (tafenoquine) under the pharmacy benefit for Commercial/Exchange members; approval is granted only when eligibility criteria including age, diagnosis, and G6PD testing are met.
No step therapy requirement
No step therapy requirement is specified for Krintafel in this policy.
Required documentation prior to authorization
Providers must document that the member is at least 16 years old, has a diagnosis of Plasmodium vivax malaria and is receiving appropriate antimalarial therapy for the acute infection, and has a G6PD test result showing >70% of normal activity prior to initiating Krintafel; requests should reflect the quantity and duration limits.
- Member age ≥ 16 years (documented)
- Diagnosis of Plasmodium vivax malaria and evidence of appropriate antimalarial therapy for acute infection
- G6PD test result > 70% of normal activity prior to initiating Krintafel
- Requested quantity and duration consistent with limits (see policy: maximum 2 tablets/300 mg and 5 days)
Denial triggers for Krintafel requests
Requests may be denied if the member is under 16 years of age, does not have a diagnosis of Plasmodium vivax malaria with concurrent appropriate therapy for the acute infection, lacks documented G6PD activity >70% of normal, or if the request exceeds the policy's quantity or duration limits.
- Member age < 16 years
- No diagnosis of Plasmodium vivax malaria or no evidence of appropriate antimalarial therapy for acute infection
- No documented G6PD testing showing >70% normal activity prior to therapy
- Requested quantity > 2 tablets (300 mg) or duration > 5 days
Background
Tafenoquine is an 8-aminoquinoline antimalarial with activity against pre-erythrocytic (liver) forms, including hypnozoites (the dormant liver stage), as well as erythrocytic (asexual) stages and gametocytes of Plasmodium species such as P. falciparum and P. vivax. Its activity against liver stages prevents development of the erythrocytic forms that cause relapses of P. vivax malaria. The drug’s approved role is in relapse prevention rather than treatment of the acute blood-stage infection.
Definitions
Revision History
Policy update effective 08/01/2026: removed prior documentation requirement and clarified approval length is five days.
Reviewed at P&T on 11/18/2020.
Reviewed at P&T on 11/20/2019.
Reviewed and updated at July P&T; removal of documentation requirement and clarification that approval length will be five days (effective 08/01/2026).
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.