Phosphate Binders
Indications for Prior Authorization
Fosrenol (lanthanum carbonate)
-
For diagnosis of Hyperphosphatemia
Indicated to reduce serum phosphate in patients with end-stage renal disease (ESRD).
Phoslyra (calcium acetate)
-
For diagnosis of Hyperphosphatemia
Indicated as an adjunct to reduction in dietary intake of phosphate and dialysis to reduce serum phosphorus in patients with kidney failure on dialysis.
Velphoro (sucroferric oxyhydroxide)
-
For diagnosis of Hyperphosphatemia
Indicated for the control of serum phosphorus levels in adult and pediatric patients 9 years of age and older with chronic kidney disease on dialysis.
Criteria
Velphoro
Step Therapy
Length of Approval: 12 Month(s)
- Both of the following:
- Diagnosis of hyperphosphatemia in chronic kidney disease on dialysis AND
- One of the following:
- Trial and failure of a minimum 30-day supply, contraindication, or intolerance to two of the following:
- calcium carbonate
- calcium acetate
- lanthanum carbonate
- sevelamer carbonate
- sevelamer HCl
- Auryxia
- Patient is younger than or equal to 12 years of age
Brand Fosrenol, Phoslyra
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure of a minimum 30-day supply, contraindication, or intolerance to two of the following:
- calcium carbonate
- calcium acetate
- lanthanum carbonate
- sevelamer carbonate
- sevelamer HCl
P & T Revisions
2024-08-26, 2024-05-18, 2023-05-24, 2022-05-31
References
- Velphoro Prescribing Information. Fresenius Medical Care North America. Waltham, MA. July 2024.
- Fosrenol Prescribing Information. Takeda Pharmaceutical Company Limited. Lexington, MA. May 2020.
- Phoslyra Prescribing Information. Layne Laboratories. Brockton, MA. September 2020.
Revision History
- 2024-08-26: update guideline
- 2024-05-18: 2024 Annual Review
- 2023-05-24: 2023 Annual Review.
- 2022-05-31: New Program
HEALTHY LIVING