Pharmacy Prior Authorization Criteria

Venxxiva (tiopronin delayed-release)

Indications for Prior Authorization

Venxxiva (tiopronin delayed-release)

• For diagnosis of Cystinuria
  Indicated, in combination with high fluid intake, alkali, and diet modification, for the prevention of cystine stone formation in adults and pediatric patients 9 years of age and older with severe homozygous cystinuria, who are not responsive to these measures alone.

Criteria

Venxxiva

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 intolerance (of a minimum 30-day supply) to both of the following:
• Brand Thiola EC
• generic tiopronin DR

P & T Revisions

2025-02-05

References

1. Venxxiva Prescribing Information. Cycle Pharmaceuticals Ltd. Cambridge, UK. December 2024.

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Revision History

• 2025-02-05: New Program

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