Pharmacy Prior Authorization Criteria

Kerendia (finerenone)

Indications for Prior Authorization

Kerendia (finerenone)

• For diagnosis of Chronic Kidney Disease Associated with Type 2 Diabetes
  Indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D).

• For diagnosis of Heart Failure with Left Ventricular Ejection Fraction (LVEF) ≥ 40%
  Indicated to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adult patients with heart failure with left ventricular ejection fraction (LVEF) ≥ 40%.

Criteria

Kerendia

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)
For diagnosis of Chronic Kidney Disease Associated with Type 2 Diabetes

• Diagnosis of chronic kidney disease (CKD) associated with type 2 diabetes (T2D)
AND
• Patient has a urine albumin-to-creatinine ratio (UACR) greater than or equal to 30 mg/g
AND
• Patient has an estimated glomerular filtration rate (eGFR) greater than or equal to 25 mL/min/1.73 m2
AND
• Patinet has a serum potassium level less than or equal to 5.0 mEq/L prior to initiating treatment
AND
• One of the following:
• Minimum 30-day supply trial of a maximally tolerated dose and will continue therapy with one of the following [2]:
• Generic angiotensin-converting enzyme (ACE) inhibitor (e.g., benazepril, lisinopril)
• Generic angiotensin II receptor blocker (ARB) (e.g., losartan, valsartan)
OR
• Patient has a contraindication or intolerance to ACE inhibitors and ARBs
AND
• One of the following:
• Patient is on a stable dose and will continue therapy with a sodium-glucose cotransporter-2 (SGLT2) inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])
OR
• Patient has a contraindication or intolerance to an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])

Kerendia

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Chronic Kidney Disease Associated with Type 2 Diabetes

• Patient demonstrates positive clinical response to therapy
AND
• One of the following:
• Patient continues to be on a maximally tolerated dose of ACE inhibitor or ARB
OR
• Patient has a contraindication or intolerance to ACE inhibitors and ARBs
AND
• One of the following:
• Patient continues to be on an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])
OR
• Patient has a contraindication or intolerance to an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])

Kerendia

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)
For diagnosis of Heart Failure with Left Ventricular Ejection Fraction (LVEF) ≥ 40%

• Diagnosis of heart failure
AND
• Patient has left ventricular ejection fraction (LVEF) greater than or equal to 40%
AND
• Patient has New York Heart Association (NYHA) Class II, III, or IV symptoms
AND
• Patient has an estimated glomerular filtration rate (eGFR) greater than or equal to 25 mL/min/1.73 m2
AND
• Patient has a serum potassium level less than or equal to 5.0 mEq/L prior to initiating treatment
AND
• Both of the following:
• Patient is on diuretic treatment (e.g., bumetanide, furosemide) for the management of symptoms of heart failure for at least 30 days prior to initiating treatment
AND
• Patient is not receiving drug in combination with spironolactone or eplerenone
AND
• One of the following:
• Patient is receiving drug in combination with a sodium-glucose cotransporter-2 (SGLT2) inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])
OR
• Patient has a contraindication or intolerance to an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])
AND
• Prescribed by or in consultation with a cardiologist

Kerendia

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Heart Failure with Left Ventricular Ejection Fraction (LVEF) ≥ 40%

• Patient demonstrates positive clinical response to therapy
AND
• One of the following:
• Patient continues to be on an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])
OR
• Patient has a contraindication or intolerance to an SGLT2 inhibitor (e.g., Farxiga [dapagliflozin], Jardiance [empagliflozin])

P & T Revisions

2025-08-26, 2024-09-19, 2024-01-11, 2022-09-23, 2021-10-12

References

1. Kerendia Prescribing Information. Bayer Healthcare Pharmaceuticals Inc. Whippany, NJ. July 2025.
2. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S): S1-S127.
3. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Journal of Cardiac Failure. Published online April 2022.
4. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 April 1;145(18):e895-1032.

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Revision History

• 2025-08-26: Updated new indication for heart failure with Left Ventricular Ejection Fraction (LVEF) ≥ 40%
• 2024-09-19: 2024 annual review: no criteria changes.
• 2024-01-11: 2023 annual review: Updated initial and reauth criteria to add requirement for concomitant use with an SGLT2i. Updated standard reauth from "documentation of.." to "patient demonstrates positive clinical response to therapy".
• 2022-09-23: Annual review: Updated initial authorization criteria.
• 2021-10-12: New Program

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