Auryxia (Ferric Citrate) oral tablets - Coverage Criteria
This policy governs prior authorization and coverage criteria for Auryxia for adult patients with chronic kidney disease for indications of hyperphosphatemia on dialysis and iron deficiency anemia in non-dialysis patients; it applies to Medical Mutual - Ohio pharmacy benefit decisions.
No material clinical or coverage changes in this revision.
Coverage Criteria for Auryxia
Hyperphosphatemia (CKD on dialysis) - Initial Coverage
Covered when ALL of the following are met:
Iron Deficiency Anemia (CKD not on dialysis) - Initial Coverage
Covered when ALL of the following are met:
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