CurrentColorado Rocky Mountain Health PlansPolicy 2026D0071O

Crysvita Burosumab Twza

Defines medical necessity criteria, initial and continuation authorization requirements, applicable provider specialties, dosing conformity to FDA labeling, and applicable HCPCS/ICD-10 codes for burosumab (Crysvita) for XLH (age ≥6 months) and FGF23-related hypophosphatemia in TIO (age ≥2 years) within UnitedHealthcare Commercial and Individual Exchange plans.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCrysvita Burosumab Twza

Policy CodePolicy 2026D0071O

Change TypeTemplate update / administrative

Effective DateMay 1, 2026

Next Review Date

Key ActionFor initial authorization, document diagnosis, age criteria, specialty prescribing/consultation, biochemical parameters (e.g., fasting serum phosphorus below age normal), and ensure dosing follows FDA labeling; initial authorization limited to ≤12 months.

SourceLink

POLICY UPDATE CHANGES

Transferred content to shared policy template that applies to both UnitedHealthcare Commercial and Individual Exchange benefit plans and added Application section.

Template Update effective 05/01/2026

2Covered Indications

12Max initial auth (months)

6 moMin age - XLH

2 yrs