CurrentUnitedHealthcarePolicy 2025 P 1440-4
Rivfloza (nedosiran) prior authorization
UnitedHealthcare prior authorization policy for Rivfloza (nedosiran) governing initial authorization and reauthorization criteria for medical-benefit use in primary hyperoxaluria type 1 (PH1), including age and kidney function requirements, prohibition of concomitant use with lumasiran (Oxlumo), and authorization duration.
Policy Summary
PayerUnitedHealthcare
PolicyRivfloza (nedosiran) prior authorization
Policy CodePolicy 2025 P 1440-4
Change TypeAdministrative updates; annual review; age limit update
Effective DateAug 1, 2025
Next Review Date
Key ActionPrior authorization is required for Rivfloza under the UnitedHealthcare medical benefit; initial and reauthorization follow the stated criteria and positive clinical response must be documented.
POLICY UPDATE CHANGES
Updated age limitation based on FDA-labeled indication.
Specified program as Prior Authorization/Notification and medical-benefit for prior UHC PA bypass.
Annual review in 5/2025 showed no changes to coverage criteria.
12 monthsAuthorization duration
>=2Minimum age (covered)
eGFR>=30Kidney function requirement
No lumasiranConcomitant therapy exclusion