Pharmacy Prior Authorization Criteria

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).

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

For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.

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
sevelamer carbonate
sevelamer HCl
Auryxia

Patient is younger than or equal to 12 years of age

Brand Fosrenol