Fursemide injection products- PA, NF
Indications for Prior Authorization
Furoscix (furosemide injection)
-
For diagnosis of Edema
Indicated for the treatment of edema in adult patients with chronic heart failure or chronic kidney disease (CKD), including the nephrotic syndrome.
Lasix Onyu (furosemide injection)
-
For diagnosis of Edema
Indicated for the treatment of edema in adult patients with chronic heart failure.
Criteria
Furoscix
Prior Authorization
Length of Approval: 1 Month(s) [A]
- Diagnosis of one of the following:
- Chronic heart failure
- Chronic kidney disease (CKD) (e.g., nephrotic syndrome)
- Drug will be used for the treatment of edema AND
- Patient is currently on maintenance oral diuretic therapy (e.g., bumetanide, furosemide, torsemide) [C] AND
- Provider attests that patient will be closely monitored for fluid, electrolyte, and metabolic abnormalities throughout therapy (e.g., hypokalemia, hypovolemia, hyponatremia) [B]
Lasix Onyu
Prior Authorization
Length of Approval: 1 Month(s) [A]
- Diagnosis of one chronic heart failure AND
- Drug will be used for the treatment of edema AND
- Patient is currently on maintenance oral diuretic therapy (e.g., bumetanide, furosemide, torsemide) AND
- Provider attests that patient will be closely monitored for fluid, electrolyte, and metabolic abnormalities throughout therapy (e.g., hypokalemia, hypovolemia, hyponatremia) [B]
Furoscix
Non Formulary
Length of Approval: 1 Month(s) [A]
- Submission of medical records (e.g., chart notes) confirming diagnosis of one of the following:
- Chronic heart failure
- Chronic kidney disease (CKD) (e.g., nephrotic syndrome)
- Drug will be used for the treatment of edema AND
- Paid claims or submission of medical records (e.g., chart notes) confirming patient is currently on maintenance oral diuretic therapy (e.g., bumetanide, furosemide, torsemide) [C] AND
- Provider attests that patient will be closely monitored for fluid, electrolyte, and metabolic abnormalities throughout therapy (e.g., hypokalemia, hypovolemia, hyponatremia) [B]
P & T Revisions
2025-12-18, 2025-10-13, 2024-11-04, 2024-10-02, 2023-04-05, 2022-12-14
References
- Furoscix Prescribing Information. scPharmaceuticals, Inc. Burlington, MA. August 2025.
- scPharmaceuticals, Inc. A Multicenter, Randomized, Open Label, Controlled Study Evaluating the Effectiveness and Safety of Furoscix On-Body Infusor vs Continued Medical Therapy for Worsening Heart Failure. clinicaltrials.gov. Published May 3, 2022.
- scPharmaceuticals, Inc. Economic Impact of Reducing Hospital Admissions for Patients Presenting to the Emergency Department With Worsening Heart Failure: An Adaptive Clinical Trial of Furoscix Infusor. clinicaltrials.gov. Published July 9, 2021.
- Lasix Onyu Prescribing Information. SQ Innovation, Inc. Burlington, MA. October 2025.
End Notes
- Furoscix and Lasix Onyu is not for chronic use and should be replaced with oral diuretics as soon as practical. [1, 4]
- Furosemide may cause fluid, electrolyte, and metabolic abnormalities such as hypovolemia, hypokalemia, azotemia, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypocalcemia, hyperglycemia, or hyperuricemia, particularly in patients receiving higher doses, patients with inadequate oral electrolyte intake, and in elderly patients. Serum electrolytes, CO , BUN, creatinine, glucose, and uric acid should be monitored frequently during furosemide therapy. [1, 4]
- Maintenance oral diuretic therapy includes those receiving 40-160 mg of oral furosemide equivalents daily (20-80 mg Torsemide or 1-4 mg Bumetanide). [3]
Revision History
- 2025-12-18: Addition of Lasix Onyu as a target drug
- 2025-10-13: Annual review: No criteria changes. Updated references.
- 2024-11-04: Annual review: No criteria changes.
- 2024-10-02: Updated guideline
- 2023-04-05: Addition of NF criteria
- 2022-12-14: New program
HEALTHY LIVING