Payer PolicyActive
Etelcalcetide Injection (Parsabiv)
EVICORE-MEDICAL_DRUG-59ACDE64
EviCore by Evernorth
Effective: December 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered: Parsabiv (etelcalcetide) is approved for secondary hyperparathyroidism in adult CKD patients receiving hemodialysis and is excluded for non‑hemodialysis/non‑CKD indications, pediatric use, or concurrent/within‑7‑days use of cinacalcet. Key requirements: patient must be on hemodialysis with corrected serum calcium ≥7.5 mg/dL and no hypocalcemia signs, initial PTH ≥300 pg/mL (reauthorization ≥100 pg/mL), dosing ≤15 mg IV bolus up to three times weekly at dialysis end, and approvals are issued for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) undergoing hemodialysis."
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