CurrentUnitedHealthcarePolicy N/A

Prior authorization criteria for Sparsentan (Filspari) and Atrasentan (Vanrafia) for IgA nephropathy

Defines UnitedHealthcare Pharmacy Clinical Pharmacy Program prior authorization and reauthorization criteria for Filspari (sparsentan) and Vanrafia (atrasentan) for adults with primary IgA nephropathy at risk for disease progression; applies to pharmacy benefit management and prescribers seeking coverage.

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization criteria for Sparsentan (Filspari) and Atrasentan (Vanrafia) for IgA nephropathy

Policy CodePolicy N/A

Change TypeNew prior authorization program

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and document diagnosis of primary IgA nephropathy and intent to slow kidney function decline (Filspari) or reduce proteinuria (Vanrafia).

SourceLink

POLICY UPDATE CHANGES

New prior authorization program created for Filspari (sparsentan) and Vanrafia (atrasentan) with criteria and 12-month authorization periods.

2medications covered by this program

12 moinitial authorization duration

12 moreauthorization duration

P&T 6/2025approval date

Coverage Criteria

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization criteria for Sparsentan (Filspari) and Atrasentan (Vanrafia) for IgA nephropathy

Policy CodePolicy N/A

Change TypeNew prior authorization program

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and document diagnosis of primary IgA nephropathy and intent to slow kidney function decline (Filspari) or reduce proteinuria (Vanrafia).

SourceLink

On This Page

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Initial Therapy — Filspari

Covered when ALL of the following are met

Filspari initial: 1) Diagnosis of primary immunoglobulin A nephropathy (IgAN); 2) Patient is at risk of disease progression; 3) Used to slow kidney function decline

Authorization issued for 12 months

Initial Therapy — Vanrafia

Covered when ALL of the following are met

Vanrafia initial: 1) Diagnosis of primary immunoglobulin A nephropathy (IgAN); 2) Patient is at risk of disease progression; 3) Used to reduce proteinuria

Approval under accelerated approval; continued approval may depend on confirmatory trial; Authorization issued for 12 months

Reauthorization

Covered when the following is met

Reauthorization: Documentation of positive clinical response

Authorization issued for 12 months

No explicit patient exclusions are listed in this policy. However, coverage decisions remain subject to member-specific benefit plan coverage, applicable state mandates, and federal regulatory requirements, which may limit or modify coverage for individual members. UnitedHealthcare may also apply medical necessity or supply limits and may approve initial or reauthorization requests based on prior claims or medication history and diagnosis codes through automated processes.

Vanrafia (atrasentan) is indicated to reduce proteinuria in adults with primary IgA nephropathy (IgAN) who are at risk for disease progression. Vanrafia received accelerated approval based on proteinuria reduction; it has not been established whether Vanrafia slows kidney function decline, and continued approval may depend on confirmatory trial results. Prior authorization is required and approvals remain subject to the program’s documentation and utilization rules.

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for Filspari. Approval is contingent on meeting the specified clinical criteria (diagnosis of primary IgA nephropathy [IgAN], patient at risk of disease progression, and use to slow kidney function decline). Authorization will be issued for 12 months.

Affected product: Filspari
Authorization duration: 12 months
Key criteria: diagnosis of primary IgAN; patient at risk of disease progression; used to slow kidney function decline

Step Therapy

No step therapy requirements are specified for these therapies in this policy.

Documentation Required

Authorization Duration and Reauthorization Documentation

Authorizations (initial and reauthorization) are issued for 12 months. Reauthorization requires documentation of positive clinical response for Filspari or Vanrafia.

Reauthorization criterion: documentation of positive clinical response
Authorization duration: 12 months (initial and reauthorization)

Denial Risk

Coverage Limitations and External Requirements

Coverage may be limited or denied if member-specific benefit plan provisions, state mandates, federal regulatory requirements, or other UnitedHealthcare policies/utilization management programs are not met. UnitedHealthcare may also approve initial or reauthorization based solely on prior claim/medication history, diagnosis codes (ICD-10), and/or claim logic. Medical necessity and supply limits may apply.

State and federal mandates, and member benefit plan terms may impact coverage
Other policies and utilization management programs may apply
Automated approvals may use prior claims/medication history, ICD-10 codes, and claim logic
Medical necessity and supply limits may be enforced

Background

Sparsentan (Filspari) is indicated to slow kidney function decline in adults with primary immunoglobulin A nephropathy (IgAN) who are at risk for disease progression. The policy references risk for progression (the source suggests a UPCR threshold is commonly used as a marker), and prior authorization criteria require a diagnosis of primary IgAN, that the patient is at risk for progression, and that the medication is intended to slow kidney function decline.

OpenPayer

Prior authorization criteria for Sparsentan (Filspari) and Atrasentan (Vanrafia) for IgA nephropathy

Coverage Criteria

Coding

Provider Actions and Requirements

Background

Definitions