Your first 90 days
Your first 90 days on Filspari for IgA nephropathy
Filspari is not a prescription you pick up at the corner pharmacy. It ships from a certified specialty pharmacy after 2 forms, a liver test and, for some people, a pregnancy test, and the dose steps up on day 15. This page lays out that stretch from the FDA label, Travere's own support program and one insurer's written rules, so the first 3 months hold no surprises.
What has to happen before the first bottle ships
Filspari is a specialty drug under a REMS, so the first fill waits on paperwork and a blood test, not on a pharmacy counter. These are the 5 things in the way, in order.
Two forms with your nephrologist
The FILSPARI Patient Start Form enrolls you with Travere TotalCare, the drugmaker's support program, and the REMS Patient Enrollment Form confirms you understand the liver risk. Your doctor must also be certified in the REMS, and only certified pharmacies can dispense. Nothing is uploaded by you.Travere TotalCare
A liver blood test, and a pregnancy test if that applies
The label requires liver enzymes (ALT and AST) and bilirubin before the first dose, and a negative pregnancy test for anyone who can become pregnant. Recent labs may count, so ask whether the ones you already have will do. The specialty pharmacy calls to confirm the test is done before it ships.FDA label
Stopping the blood pressure pill that works the same way
The label says to stop any ACE inhibitor or ARB, such as lisinopril, losartan or irbesartan, and any endothelin receptor antagonist or aliskiren before starting, because Filspari must not be taken with them. In the PROTECT trial that happened the day before the first dose. Your nephrologist sets the timing.FDA label
A call from a nurse educator
Once the start form is in, a Travere TotalCare nurse educator calls to explain what to expect, check your insurance, set up free at-home lab draws if you qualify, and tell you which specialty pharmacy will ship the drug. They work in English, Spanish and Mandarin.Travere TotalCare
The insurance approval
Most plans require prior authorization. The specialty pharmacy and the nurse educator chase it, but it is worth knowing the usual criteria, which are further down this page, so you can tell whether a delay is paperwork or a real gap.Express Scripts policy
The days that matter
Counted from the first dose, with the label's dose step on day 15, the monthly refill and the liver test every 3 months. Type your first-dose date and the tiles become real dates you can add to your calendar.
Forms signed, labs drawn
Start Form, REMS enrollment and the liver and pregnancy tests. Travere suggests scheduling labs early so a late result does not hold up the delivery.
The specialty pharmacy calls
It confirms the lab result, your address and a delivery window. Answering that call is the single most common thing that delays a first fill.
First dose, 200mg once a day
One tablet, swallowed whole with water before the same meal each day, morning or evening. A bottle holds 30 tablets.
Step up to 400mg once a day
After 14 days the label raises the dose to 400mg if the first 2 weeks were tolerated. That means a new strength, so the pharmacy ships 400mg tablets for this date.
First refill
Thirty tablets a bottle means a refill lands about here and every month after. The pharmacy calls before each one, and a lapsed call can mean a missed shipment.
Liver test, then every 3 months
The label requires ALT, AST and bilirubin before starting and then every 3 months for as long as you take Filspari. The pharmacy will not ship a refill until the REMS shows the test is done. Travere TotalCare offers the draw at home at no cost for eligible patients.
Liver test, number 2
How the label says to take it
The parts of the prescribing information and the Medication Guide that come up in the first 3 months, in plain words.
- Before the same meal, every day
The Medication Guide says to take the tablet whole with water before your morning or evening meal, and before the same meal each day. Food changes how much is absorbed, so the timing is part of the dose.Medication Guide
- If you miss a dose
Skip it and take the next dose at the usual time. The Medication Guide says never to take 2 doses at once or an extra dose.Medication Guide
- If you stop for a while and restart
The label says that after an interruption, prescribers should consider restarting at half the usual dose and stepping back up after 14 days, the same way treatment began. That is a decision for your nephrologist, and it is the reason a long gap is worth a call rather than a quiet restart.FDA label
- If you cannot swallow the tablet
It can be crushed and mixed in half a cup of water right before taking it, and the whole cup drunk at once. The label says not to use any other liquid and not to store the mixture.FDA label
- Medicines that do not mix
Filspari must not be taken with an ARB, another endothelin receptor antagonist or aliskiren. The label also says to avoid strong CYP3A inhibitors, such as some antifungals and antibiotics, to be careful with NSAIDs because of the kidney, and to watch potassium with supplements or salt substitutes. Tell the pharmacist everything you take, including over the counter.FDA label
- Pregnancy and birth control
Filspari must not be taken during pregnancy. The label requires effective contraception during treatment and for 2 weeks after stopping, and says to contact the prescriber at once if pregnancy is suspected. Breastfeeding is advised against.FDA label
- Storage
Room temperature, in the original bottle, which has a child-resistant cap. No refrigeration.FDA label
What the label says to act on
The symptoms the label singles out, and what it tells patients and prescribers to do about each. If any of these happen, the label's instruction is the one to follow, with your care team.
Signs the label ties to the liver
Nausea, vomiting, pain under the right ribs, unusual tiredness, loss of appetite, yellowing of the skin or eyes, dark urine, fever or itching. The label says to stop the drug and seek medical attention right away for these, not to wait for the next scheduled test.FDA label
Low blood pressure and dizziness
The most common side effects in the IgAN trial were high potassium in 17%, low blood pressure in 16%, swelling in 16% and dizziness in 16%, against lower rates on irbesartan. Faintness or dizziness in the first weeks is what the label's low blood pressure warning is about, and the label asks prescribers to review other blood pressure medicines if it happens, so it is worth reporting early.FDA label
Swelling
Fluid retention occurred in the trials. The label asks prescribers to look for the cause and consider a diuretic or a dose change if it is significant, so new swelling in the legs is worth reporting rather than waiting out.FDA label
Why the pharmacy or the insurer says no, and what fixes it
Most first-fill delays are one of these. Knowing which one tells you who to call.
- The REMS does not show a current liver testThe pharmacy cannot ship until it does. Ask the nurse educator about the free at-home draw, or ask the doctor's office to send the result to the REMS.Travere TotalCare
- The prescription went to a retail pharmacyOnly REMS-certified specialty pharmacies can fill Filspari. The nurse educator or the prescriber's office redirects it. This is a routing error, not a denial.Travere TotalCare
- Prior authorization not yet approvedThe insurer wants the criteria below documented, most often the biopsy, the protein level and the 12 weeks on an ACE inhibitor or ARB. The nephrologist's office supplies the records, and the nurse educator can track it.Express Scripts policy
- Step therapy or a non-formulary noticeSome plans require a documented trial of an ACE inhibitor or ARB first. If you have had one, the records settle it. If the plan excludes the drug, Travere TotalCare and the foundations' funds are the next calls.Express Scripts policy
- A copay you cannot payCommercial insurance: the Travere $0 copay program, up to an annual maximum. Medicare or Medicaid: the copay program is barred by law, so the nurse educator points to charity funds, and our help paying page lists which are open.Travere TotalCare
Express Scripts prior authorization policy, February 28, 2024
- Age 18 or older, with IgA nephropathy confirmed by biopsy
- Protein in the urine above 1g a day, or a urine protein-to-creatinine ratio of 1.5g/g or higher
- At least 12 weeks on the highest tolerated dose of an ACE inhibitor or an ARB before starting
- At least 3 months of supportive care, meaning blood pressure control, lifestyle and heart risk measures
- Kidney function (eGFR) of 30 or higher
- Not combined with an ACE inhibitor, ARB, another endothelin receptor antagonist or aliskiren
- Prescribed by or with a nephrologist
Approval length. 9 months for the first approval, then 1 year at a time if the protein level has come down.
This policy was written while Filspari held accelerated approval for proteinuria and before the FDA's full approval to slow kidney decline, so other plans and newer versions may set a lower protein threshold. It is here as an example of what a plan asks for, not as a rule. Express Scripts policy
Who to call, and what they can do
The drugmaker's program handles most of the first-fill problems above. Charity funds and foundation help are on the help paying page.
- A nurse educator for the whole course of treatment, by phone, text, email or video, in English, Spanish and Mandarin
- $0 copay program for eligible people with commercial insurance, up to an annual maximum, not available on Medicare, Medicaid or TRICARE
- Free at-home REMS liver testing for eligible patients
- Help understanding coverage on Medicare and Medicaid, and a check for other support if you have no insurance
Trial Friend takes no money from this program. Travere TotalCare
Five questions for the pharmacist or nurse educator
- Which specialty pharmacy is mine, and what number do they call from, so I do not miss the delivery call?
- Will the 400mg tablets for day 15 arrive with the first shipment or separately?
- Is my liver test due date in the REMS, and who sends the result there?
- I take these other medicines and supplements. Does any of them interact?
- If I miss the refill call, how many days do I have before the shipment is cancelled?
Questions people ask in the first weeks
How long does it take to get Filspari after it is prescribed?
There is no fixed number, because the forms, the liver test, the insurance approval and the pharmacy call each take their own time. Travere's own guidance is to schedule the labs early so the delivery is not held up, and to answer the specialty pharmacy's calls.
Can I pick up Filspari at my regular pharmacy?
No. Because of the REMS, only certified specialty pharmacies can dispense it, and they deliver to your home. The nurse educator tells you which one is yours.
What if I miss a dose of Filspari?
The Medication Guide says to skip it and take the next dose at the normal time, and never to double up. A longer gap is different, because the label suggests restarting at half dose and stepping up again, so call the prescriber before restarting after days off.
How often are liver tests required on Filspari?
Before the first dose and then every 3 months for as long as you take it, under the April 2026 label. The pharmacy will not ship a refill without a current result in the REMS.
Does Filspari have to be taken with food?
Before a meal, and before the same meal each day, morning or evening. That timing is written into the label because food affects absorption.
Why was Filspari denied by my insurance?
Most often because the plan wants proof of a biopsy, a protein level above its threshold, or 12 weeks on an ACE inhibitor or ARB first. The nephrologist's records usually resolve it, and the nurse educator can follow the appeal.
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Sources
- FILSPARI (sparsentan) prescribing information, sections 2, 5, 7, 16 and 17, revised April 2026, Travere Therapeutics, via openFDA and DailyMed, April 9, 2026.
- FILSPARI Medication Guide, How should I take FILSPARI, Travere Therapeutics, via DailyMed, April 9, 2026.
- Travere TotalCare patient support for FILSPARI, Travere Therapeutics, May 1, 2026.
- Nephrology, Filspari Prior Authorization Policy, Express Scripts, February 28, 2024.
This page explains what the FDA label, the drugmaker's support program and an insurer policy say. It is not medical advice and does not tell anyone to start, stop or change a medicine. Dosing, lab timing and restarts after a gap are decisions for the prescribing nephrologist. Found an error? Use the report link in the footer and it will be checked against the source.