Yorvipath_Medical_Necessity_Criteria
Prior authorization / medical necessity criteria for Yorvipath (palopegteriparatide) for treatment of hypoparathyroidism in adults, including initial authorization and reauthorization clinical requirements, prescriber specialty, and authorization duration.
New program established and P&T approval recorded (12/2024) with annual review (12/2025) noting no changes.
Coverage Summary
Coverage stance: covered_with_criteria for Yorvipath (palopegteriparatide) as treatment of hypoparathyroidism in adults. Scope: prior authorization / medical necessity criteria covering initial authorization and reauthorization clinical requirements, prescriber specialty, and authorization duration. Key initial-authorization criteria include confirmed diagnosis of hypoparathyroidism with pretreatment albumin-corrected serum calcium ≤ 8.5 mg/dL on at least two occasions ≥ 2 weeks apart and pretreatment intact PTH < 20 pg/mL on at least two occasions, exclusion of acute post-surgical hypoparathyroidism, evidence of adequate supplemental calcium and active vitamin D with on-therapy albumin-corrected serum calcium 7.8-10.6 mg/dL and serum 25(OH) vitamin D ≥ 20 ng/mL, and prescription by an endocrinologist or nephrologist. Authorization duration when approved: 12 months. Effective date: 2026-03-01; Last review: 2025-12-01.
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