Vpriv (velaglucerase alfa) — Medical Benefit Medication Utilization Policy (Gaucher disease type 1)
Medical benefit policy governing initial and continuation coverage criteria, quantity limits, authorization period, and applicable billing code for velaglucerase alfa (Vpriv) when used to treat Gaucher disease type 1.
No material clinical or coverage changes in this revision.
Coverage Criteria for Vpriv (velaglucerase alfa)
Initial Therapy
Covered when ALL of the following are met:
Initial approval criteria for Gaucher disease type 1
- At least one treatment indication: Severe anemia (Hb < 8 mg/dL) OR severe thrombocytopenia (< 60,000 cells/mL) OR absolute leukocyte count < 3,000 cells/mL OR symptomatic bone disease (prior bone crisis and osteonecrosis) OR active bone disease OR pubertal delay OR sibling with severe disease requiring enzyme replacement or substrate reduction therapy OR genotype associated with severe disease OR height < 5th percentile or significantly decreased growth velocity OR bone mineral density Z-score < -2.0 OR spleen volume > 2.0 MN with liver volume > 2.0 MN
Continuation Therapy
Covered when ALL of the following are met:
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