Rezdiffra™ (resmetirom) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Defines UnitedHealthcare commercial plan prior authorization and medical necessity criteria for Rezdiffra (resmetirom) for adults with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH/NASH) with fibrosis stage F2–F3, plus reauthorization, prescribing provider requirements, and additional clinical/billing rules. Includes limits (avoid in decompensated cirrhosis) and references.
New prior authorization program created for Rezdiffra (resmetirom).
Revised initial authorization criteria for confirming fibrosis stage F2 or F3; added reauthorization requirement that patient has not progressed to cirrhosis; updated references.
Added combination use language and medical record submission requirement to initial authorization criteria for confirming fibrosis stage F2 or F3.
Administrative correction to change control language with no change to coverage criteria.