All PlansPrior AuthLow impact
Nedosiran (Rivfloza™)
BCBS Tennessee·TN · Nephrology, Urology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New coverage policy for Nedosiran (Rivfloza™) for primary hyperoxaluria type 1 treatment, requiring prior authorization with genetic testing confirmation and specialist prescription. Policy requires 12-month authorization cycles with specific coverage criteria including age 2+, preserved kidney function, and cannot be combined with Oxlumo.
Action Required
By July 31, 2026: Billing team must implement prior authorization requirements for Nedosiran (Rivfloza™) prescriptions. Ensure geneticists, nephrologists, and urologists are aware of documentation requirements including genetic testing results and baseline oxalate levels. Set up 12-month authorization tracking for approved cases. Claims will require prior auth or will be denied.