Step therapy requirement for Sephience (sepiapterin)
Defines UnitedHealthcare's step therapy requirement that members must try sapropterin dihydrochloride before receiving coverage for Sephience (sepiapterin) for treatment of sepiapterin-responsive PKU; applies to members covered under UnitedHealthcare pharmacy benefits.
New step therapy program requiring trial of sapropterin dihydrochloride prior to coverage of Sephience.
Coverage Criteria
Members with a documented history of receiving Sephience (sepiapterin) in the claims record will be allowed continued coverage without meeting the step therapy trial requirement. Prior authorization remains required for Sephience, and authorizations are issued for 12 months. New-to-therapy members must meet the initial coverage criteria, but continuation requests for members already on Sephience as shown in claims do not need to demonstrate a prior trial of sapropterin.
Initial Therapy
Initial therapy — initial authorization criteria for Sephience
Initial authorization criteria for Sephience
Continuation Criteria
Continuation — continuation of therapy rules for Sephience
Continuation of therapy rules
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