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DrugLokelma™ (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


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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