Kuvan (sapropterin) — Pharmacy Coverage and Prior Authorization
This policy governs prior authorization, coverage criteria, and dispensing details for Kuvan (sapropterin) for treatment of BH4-responsive phenylketonuria (PKU) for CareSource members in Arkansas/PASSE.
New policy for Kuvan created.
Removed prescriber specialty requirement and Phe level documentation.
Coverage Criteria for Kuvan (sapropterin)
inv-01: Initial Therapy — Initial authorization — Covered when ALL of the following are met
Initial authorization — Covered when ALL of the following are met
If all the above requirements are met, approve for 2 months.
inv-02: Continuation/Refill — Reauthorization — Covered when ANY of the following are met
Reauthorization — Covered when ANY of the following are met
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