Prevymis®

Drug - Prevymis® (letemovir) [Merck and Co., Inc.]

July 2025

Therapeutic Area - Antivirals, General

Approval criteria

  • Patient is a kidney transplant recipient AND
  • Patient is at high risk for cytomegalovirus (CMV) disease (Donor CMV seropositive/Recipient CMV seronegative [D+/R-])

    OR

  • Patient is an allogeneic hematopoietic stem cell transplant (HSCT) recipient AND
  • Patient is CMV-seropositive (R+)

    AND

  • Prevymis is being prescribed as prophylaxis and NOT treatment of CMV infection AND
  • Patient’s age is within FDA labeling for the requested indication for Prevymis AND
  • When applicable, the patient’s weight is within FDA labeling for the requested indication for Prevymis AND
  • Patient does NOT have any FDA labeled contraindications to Prevymis
  • Approval is effective for 9 months from approval date

Quantity limits

  • Daily quantity limit and prophylaxis duration will NOT exceed those recommended in the FDA-approved label
  • Patient’s weight (in kg) must be submitted at time of request, when applicable.

Billing for Prevymis

  • Intravenous infusion:  must be billed as a professional claim
  • Tablets and oral pellets:  must be billed as a pharmacy claim

Questions

Provider Call Center (844) 575-7887