Lokelma™
Drug - Lokelma™ (sodium zirconium cyclosilicate powder) [AstraZeneca Pharmaceuticals LP]
June 2019
Therapeutic area - Hyperkalemia
Initial approval criteria
Patient must:
- Be ≥ 18 years of age AND
- Have a diagnosis of chronic hyperkalemia AND
- Have had an adequate trial and failure of sodium polystyrene sulfonate
- Initial approval is for 15 days
Renewal criteria
- Continue to meet initial request criteria AND
- Have an absence of treatment-limiting adverse effects (e.g. edema) AND
- Have documented efficacy (e.g., serum potassium levels within normal limits [3.5 to 5 mEq/L])
- Renewal approval is for 15 days
Quantity limits
- Initial request: 19 packets/15 days
- Renewals: 15 packets/15 days
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411