Premera Bluecross EB topical therapy Coverage

Initial therapy

Covered when ALL of the following are met

Prescriber requirement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrent therapy exclusion: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial therapy / coverage criteria

Covered when ALL of the following are met

No concurrent products: Zevaskyn (prademagene zamikeracel) will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

explicit concurrent-use exclusion

Prescriber requirement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

must be documented

Administration requirement: Zevaskyn (prademagene zamikeracel) will be applied by a healthcare provider

in-person/provider application required

Indication requirement: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

clinical indication

Coverage Criteria

Covered when ALL of the following are met

Concurrent use: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt).

Explicit prohibition of concurrent topical therapies

Prescriber requirement: Use is prescribed by or in consultation with a dermatologist or medical geneticist.

Application requirement: Zevaskyn will be applied by a healthcare provider.

Indication requirement: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds.

Initial coverage criteria

Covered when ALL of the following are met

Specialist involvement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrency restriction: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial Therapy / Coverage Conditions

Covered when ALL of the following are met

Primary coverage criteria: Use is prescribed by or in consultation with a dermatologist or medical geneticist AND Zevaskyn will be applied by a healthcare provider AND Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrent use prohibition listed separately

Coverage Criteria for Zevaskyn

Covered when ALL of the following are met:

Prescriber: Use is prescribed by or in consultation with a dermatologist or medical geneticist

supported in chunks 110,113

Administration: Zevaskyn will be applied by a healthcare provider

supported in chunks 110,113

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

supported in chunks 110,113

Concurrent use: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

supported in chunks 110,113

Coverage conditions

Covered when ALL of the following are met

Specialist involvement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrent use restriction: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial coverage criteria for Zevaskyn

Covered when ALL of the following are met

Specialist: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn (prademagene zamikeracel) will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrent therapy: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial therapy / coverage criteria

Covered when ALL of the following are met

Specialist involvement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration setting/provider: Zevaskyn will be applied by a healthcare provider

Indication for use: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrent therapy exclusion: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial and ongoing coverage criteria

Covered when ALL of the following are met

Prescriber: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrency: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial therapy / Medical necessity

Covered when ALL of the following are met

Prescriber requirement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration requirement: Zevaskyn will be applied by a healthcare provider

Indication requirement: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Exclusion of concurrent therapy: Will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial coverage criteria

Covered when ALL of the following are met

Prescriber: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn (prademagene zamikeracel) will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrency: Will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial coverage criteria

Covered when ALL of the following are met

Prescriber requirement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Document specialty or consultation

Application requirement: Zevaskyn will be applied by a healthcare provider

Must be provider‑applied (not self‑applied)

Indication requirement: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Indication must be clearly documented

Concurrent therapy exclusion: Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Initial / Continued use

Covered when ALL of the following are met

All required conditions: Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek; use is prescribed by or in consultation with a dermatologist or medical geneticist; Zevaskyn will be applied by a healthcare provider; requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds.

Exact repeated phrasing present in document.

Concurrent topical use of the three named agents is prohibited. Filsuvez, Vyjuvek, and Zevaskyn must not be used concurrently, and a product will not be used on wounds being treated with one of the other named products.

Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec‑svdt). This concurrent‑use exclusion is explicitly stated as a condition of coverage.

Zevaskyn will not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec‑svdt). The policy repeats this exclusion across coverage criteria for Zevaskyn.

Concurrent use of Zevaskyn with Filsuvez or Vyjuvek is excluded. The coverage criteria list this as an explicit prohibition that may affect authorization.

The policy reiterates that Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek, and that this concurrency restriction is part of the initial coverage requirements.

For Zevaskyn specifically, the coverage criteria state that it will not be used concurrently with Filsuvez or Vyjuvek and further note that neither Vyjuvek nor Filsuvez should be used on wounds treated with Zevaskyn.

Concurrent use of Zevaskyn with Filsuvez or Vyjuvek may trigger denial. The policy flags concurrent product use as a denial risk for authorization requests.

Coverage language repeats that Zevaskyn must not be used concurrently with Filsuvez or Vyjuvek; this concurrency exclusion is presented alongside prescriber and administration requirements.

The policy again states as coverage conditions that Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek, reinforcing the prohibition across multiple sections.

The documented coverage criteria list concurrent therapy with Filsuvez or Vyjuvek as prohibited for Zevaskyn and note that such concurrent use may result in denial.

The policy reiterates the concurrency restriction: Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek, cited as an exclusion within coverage conditions.

Requests may be denied if Zevaskyn is used concurrently with Filsuvez or Vyjuvek. The concurrency exclusion is listed as a trigger for denial in the authorization guidance.

The coverage statements consistently require that Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek, and this condition is included among the items needed for approval.

Coverage language repeats that Zevaskyn must not be used concurrently with Filsuvez or Vyjuvek, and the concurrency restriction is part of the required conditions for use.

The policy restates the same exclusion: Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek. This concurrent‑use exclusion is framed as a required condition for authorization and may prompt denial if violated.

Across the document fragments, the coverage criteria are consistently summarized: Zevaskyn will not be used concurrently with Filsuvez or Vyjuvek, and ongoing use must meet the same concurrency and clinical conditions.

In addition to the concurrency exclusion, the policy requires specialty involvement and application setting for covered use: requests must document that the agent is prescribed by or in consultation with a dermatologist or medical geneticist, and that Zevaskyn will be applied by a healthcare provider for the covered wound indications.

Zevaskyn coverage is limited to treatment of new expansion of pre‑existing wounds, new wounds, or open wounds in patients meeting genetic and wound criteria; the policy repeatedly states that Zevaskyn must be provider‑applied and prescribed by or in consultation with a dermatologist or medical geneticist.

Initial Therapy Criteria

Filsuvez initial therapy

Initial therapy requirements for Filsuvez

Initial Filsuvez nodes: See coverage.criteria_sets Filsuvez

Vyjuvek initial therapy

Initial therapy requirements for Vyjuvek

Initial Vyjuvek nodes: See coverage.criteria_sets Vyjuvek

Zevaskyn initial therapy

Initial therapy requirements for Zevaskyn

Initial Zevaskyn nodes: See coverage.criteria_sets Zevaskyn

Initial therapy

Initial authorization requires ALL of the following

Prescriber or consult: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration by HCP: Zevaskyn will be applied by a healthcare provider

Clinical indication: For treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Initial therapy

Prescriber/consult: Use is prescribed by or in consultation with a dermatologist or medical geneticist

required

Provider application: Zevaskyn will be applied by a healthcare provider

required

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

required

Initial therapy

Initial therapy requirements: Prescribed by or in consultation with a dermatologist or medical geneticist; applied by a healthcare provider; used to treat new expansion of pre-existing wounds, new wounds, or open wounds; not used concurrently with Filsuvez or Vyjuvek.

Initial therapy criteria

Prescriber: Prescribed by or in consultation with a dermatologist or medical geneticist

Application: Applied by a healthcare provider

Indication: For new expansion of pre-existing wounds, new wounds, or open wounds

No concurrent therapy: Not used concurrently with Filsuvez or Vyjuvek

Initial therapy

Initial therapy: Prescribed by or in consultation with a dermatologist or medical geneticist; applied by a healthcare provider; for new expansion of pre-existing wounds, new wounds, or open wounds

Initial therapy

Initial therapy conditions: Prescribed by or in consultation with a dermatologist or medical geneticist; applied by a healthcare provider; used for new expansion of pre-existing wounds, new wounds, or open wounds; not used concurrently with Filsuvez or Vyjuvek

chunks 110,113

Initial therapy criteria

Specialist involvement: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Initial therapy requirements

Specialist prescription: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Provider application: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Initial coverage conditions

Prescriber or consult: Use is prescribed by or in consultation with a dermatologist or medical geneticist

Application: Zevaskyn will be applied by a healthcare provider

Indication: Requires treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Initial therapy criteria

Prescriber: Prescribed by or in consultation with a dermatologist or medical geneticist

Administration: Applied by a healthcare provider

Indication: For treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrency exclusion: Not to be used concurrently with Filsuvez or Vyjuvek

Initial therapy

Initial coverage conditions: Prescribed by or in consultation with a dermatologist or medical geneticist; applied by a healthcare provider; for new expansion of pre-existing wounds, new wounds, or open wounds; not used concurrently with Filsuvez or Vyjuvek.

Initial therapy requirements

Prescriber: Prescribed by or in consultation with a dermatologist or medical geneticist

Application: Applied by a healthcare provider

Indication: For treatment of new expansion of pre-existing wounds, new wounds, or open wounds

Concurrency: Not to be used concurrently with Filsuvez or Vyjuvek

Initial therapy criteria

Initial therapy is allowed when all authorization requirements are met

Prescriber: Prescribed by or in consultation with a dermatologist or medical geneticist

Application: Applied by a healthcare provider

Indication: For treatment of new expansion of pre-existing wounds, new wounds, or open wounds

No concurrent use: Not used concurrently with Filsuvez or Vyjuvek

Initial therapy

Initial therapy criteria: Prescribed by or in consultation with a dermatologist or medical geneticist; applied by a healthcare provider; indicated for treatment of new expansion of pre-existing wounds, new wounds, or open wounds; not used concurrently with Filsuvez or Vyjuvek.

Directly from coverage text.

Provider Actions & Authorization Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required. Requests must document that the patient meets the medical necessity criteria for the requested product and that the prescriber and intended administration comply with policy requirements.

Prior authorization required for Filsuvez, Vyjuvek, and Zevaskyn
When Zevaskyn is requested, authorization must confirm specialist involvement, provider-applied administration, and indication for new/expanding/open wounds
Prior authorization requests must include documentation that the product will not be used concurrently with the other named agents where the policy prohibits concurrent use

Denial Risk

Concurrent Use Exclusion

Concurrent use of Filsuvez, Vyjuvek, and Zevaskyn is prohibited. Authorization will be denied if the requested product is to be used concurrently with any of the other listed products.

Explicit policy exclusion: no concurrent use of Filsuvez, Vyjuvek, and Zevaskyn
If patient is currently receiving or plans to receive one of the other listed products, request will not be approved

Documentation Required

Required Documentation

Required documentation must accompany prior authorization requests. Include demographic and clinical details that demonstrate the indication meets policy criteria, and evidence of specialist involvement and planned administration.

Patient age and confirmed genetic testing results (diagnosis and mutation where specified)
Wound description: type, size, chronicity (e.g., duration >= policy threshold), and whether for new/expanding/open wounds when applicable
Confirmation of negative pregnancy status where required (Vyjuvek, Zevaskyn)
History of squamous cell carcinoma in the wound (absence required for Vyjuvek and Zevaskyn)
Prescriber is a dermatologist or medical geneticist, or consultation documentation from one
Planned administration details: whether product will be applied by a healthcare provider (required for Zevaskyn)
Statement that requested product will not be used concurrently with Filsuvez, Vyjuvek, or Zevaskyn as applicable

Denial Risk

Denial Triggers

Requests that do not meet policy criteria are at risk for denial. Common denial triggers include missing or inadequate documentation of diagnosis/mutation, patient age outside policy limits, wound characteristics not meeting thresholds, pregnancy when prohibited, history of squamous cell carcinoma in the wound, lack of required specialist involvement, lack of documentation that a healthcare provider will apply the product (when required), or evidence of concurrent use with excluded products.

Missing genetic testing or mutation documentation (COL7A1 where required)
Wounds not meeting size/duration thresholds (e.g., Filsuvez: open wound ≥21 days; Zevaskyn: wounds present ≥3 months and adequate size)
Pregnancy not confirmed negative when required
Current or prior squamous cell carcinoma in wound where policy excludes use
Prescriber is not a dermatologist or medical geneticist and no consultation documented
No documentation that Zevaskyn will be applied by a healthcare provider when policy requires provider application
Any plan for concurrent use of the listed products

Step Therapy

No step therapy requirements are present in this section of the policy.

Step	Requirement
1
Concurrent use of Filsuvez (birch triterpenes), Vyjuvek (beremagene geperpavec‑svdt), and Zevaskyn (prademagene zamikeracel) is prohibited; use of one agent requires documentation that it will not be used concurrently with the others and will not be used on wounds treated with the other named products.

Step	Requirement
1
May not be used concurrently with the specified alternatives (Filsuvez or Vyjuvek). Prior authorization must document that use is prescribed by or in consultation with a dermatologist or medical geneticist and that the product will be applied by a healthcare provider for the indicated wounds.

Application / Site of Care Requirements

Billing Rule

Application must be performed by a healthcare provider

Zevaskyn must be applied by a healthcare provider; other agents are topical prescriptions to be used per prescriber direction.

Site of care implied: office/infusion or other clinical setting where provider application occurs.

Billing Rule

Site of care: provider‑applied in clinical setting

Zevaskyn must be applied by a healthcare provider (implies clinic/office/infusion setting rather than self‑administration).

Billing Rule

Provider application implies outpatient/office setting

Zevaskyn must be applied by a healthcare provider (site implied outpatient/office or infusion‑type setting where provider application occurs).

Billing Rule

Provider application required for billing

Zevaskyn must be applied by a healthcare provider (implies clinic/office/infusion setting rather than self‑application).

Billing Rule

Document provider administration site

Application of Zevaskyn must be performed by a healthcare provider (implies administration in a clinical setting).

Billing Rule

Provider‑applied administration required

Zevaskyn must be applied by a healthcare provider (implies administration in a clinical setting by a provider).

Billing Rule

Application site: clinical/supervised care setting

Zevaskyn must be applied by a healthcare provider (implies administered in a clinical or supervised care setting).

Billing Rule

Provider application — implied site of care

Zevaskyn must be applied by a healthcare provider (provider‑applied setting implied).

Billing Rule

Provider application required (site unspecified)

Zevaskyn must be applied by a healthcare provider (site not otherwise specified).

Billing Rule

Provider application — clinical administration implied

Zevaskyn must be applied by a healthcare provider (implies administration in a provider setting).

Billing Rule

Provider application — clinic/office/infusion setting

Zevaskyn must be applied by a healthcare provider (implies clinic/office/infusion setting as appropriate for topical application).

Billing Rule

Provider application required for administration billing

Zevaskyn must be applied by a healthcare provider (site implied as clinic/office or infusion/application setting where a provider applies the product).

Billing Rule

Provider‑applied administration required (billing implication)

Zevaskyn must be applied by a healthcare provider (implies clinic/office or infusion/application setting rather than self‑administration).

Billing Rule

Provider application — clinic/infusion/office implied

Zevaskyn must be applied by a healthcare provider (implying clinic/infusion or office setting rather than self‑administration).

Billing Rule

Administration must be performed by a healthcare provider

Application of Zevaskyn must be performed by a healthcare provider.

Definitions & Key Terms

EB categories — definitions

EB major categoriesEpidermolysis bullosa simplex (EBS); junctional EB (JEB); dystrophic EB (DEB); kindler EB (KEB)

Clinical featuresSkin fragility with blistering, erosions, nonhealing ulcers, and scarring after minor trauma

Pathophysiology summaryAbnormal structures at the dermal-epidermal junction or basal epidermis causing increased susceptibility to mechanical injury

Applied by a healthcare provider

DefinitionApplied by a healthcare provider: product application performed by a clinician (not self-applied)

Implication for site of careAdministration implies clinic/office/infusion or other supervised setting where a provider performs application

Documentation requirementAuthorization records must indicate that application will be performed by a healthcare provider

Concurrent use prohibition

Concurrent-use prohibitionZevaskyn must not be used concurrently with Filsuvez (birch triterpenes) or Vyjuvek (beremagene geperpavec-svdt)

Wound-level restrictionThese agents will not be used on wounds treated with the other named products

Authorization consequenceConcurrent use with the listed agents may trigger denial of coverage

Indication phrase (excerpt)

Phrase'new expansion of pre-existing wounds, new wounds, or open wounds' — clinical indication phrase used in the policy

Use contextRequired indication for Zevaskyn treatment per coverage criteria

DocumentationRecords must document that treatment is for new expansion of pre-existing wounds, new wounds, or open wounds

Zevaskyn — product identity & restrictions

Product identityZevaskyn (prademagene zamikeracel)

Therapeutic classTopical gene/cellular therapy for epidermolysis bullosa (topical biologic)

Coverage restrictionWill not be used concurrently with Filsuvez or Vyjuvek; must be applied by a healthcare provider and prescribed by or in consultation with a dermatologist or medical geneticist

Covered indication

Covered indicationTreatment of new expansion of pre-existing wounds, new wounds, or open wounds

Required prescriber involvementPrescribed by or in consultation with a dermatologist or medical geneticist

Administration requirementWill be applied by a healthcare provider (not self-applied)

Zevaskyn — product name

Product nameZevaskyn

Generic/activeprademagene zamikeracel

Formulation noteTopical therapy referenced throughout the coverage criteria

Zevaskyn — product name (alternate)

Product name (alternate)Zevaskyn (prademagene zamikeracel)

Policy mentionsRepeatedly referenced in coverage criteria and exclusions

RolePrimary topical therapy for specified wound indications in RDEB

Concurrent-use restricted products

Concurrent-use restricted productsFilsuvez (birch triterpenes); Vyjuvek (beremagene geperpavec-svdt)

Policy effectThese products are explicitly listed as not to be used concurrently with Zevaskyn

Coverage implicationConcurrent use may lead to denial of coverage for Zevaskyn

Zevaskyn — identity & use summary

Summary statementZevaskyn (prademagene zamikeracel) — topical therapy for treatment of qualifying EB wounds

Key conditionsPrescriber specialty, provider application, specific wound indications, and nonconcurrent use with Filsuvez or Vyjuvek

Repeated requirementCoverage criteria are repeated across the document to emphasize conditions

Will be applied by a healthcare provider — definition

Definition'Will be applied by a healthcare provider' means application performed by clinician rather than self-application

Authorization noteDocumentation must indicate provider will perform application

Site of careImplies office/clinic/infusion or similar supervised setting

Indication — required wound types

Indication requirementRequired to treat new expansion of pre-existing wounds, new wounds, or open wounds

Clinical documentationRecords must document the wound(s) meet the described indication

Applies to ZevaskynThis indication is repeatedly cited as the condition for coverage

Zevaskyn (prademagene zamikeracel) — reference

Product referenceZevaskyn (prademagene zamikeracel)

ContextNamed as the topical agent subject to coverage criteria and concurrency exclusions

Regulatory/formulation noteReferred to consistently as a topical therapeutic in the policy

Prescriber qualification

Prescriber qualificationUse must be prescribed by or in consultation with a dermatologist or medical geneticist

DocumentationAuthorization should include prescriber specialty or consult note

RationaleSpecialist involvement required across repeated coverage statements

Administration setting

Administration settingApplication performed by a healthcare provider (not self-applied)

ImplicationSite of care is clinic/office/infusion or similar supervised setting

Authorization noteDocumentation must state provider will perform application

Covered indication — concise

Covered indication (concise)Treatment limited to new expansion of pre-existing wounds, new wounds, or open wounds

Not covered usesUse for other indications is not supported in this policy section

DocumentationIndication must be clearly documented for authorization

Zevaskyn — alternate reference

Product mentionZevaskyn (prademagene zamikeracel)

Repeated referencesMultiple chunks reference the same product name verbatim

Use casePrimary topical therapy in criteria for RDEB wound treatment

Indication phrase — repetition

Phrase repetition'new expansion of pre-existing wounds, new wounds, or open wounds' repeated as the clinical indication

Coverage roleThis phrase defines the target wounds for which Zevaskyn is authorized

Documentation implicationRecords must link use to this indicated wound status

Zevaskyn — product reference (alternate)

Product referenceZevaskyn (prademagene zamikeracel)

Policy roleNamed repeatedly as the topical agent subject to coverage criteria and exclusions

Clinical scopeUsed for specified wound indications in patients with EB per criteria

Concurrent‑use exclusions

Concurrent‑use exclusions (summary)Filsuvez (birch triterpenes) and Vyjuvek (beremagene geperpavec-svdt) are listed as not to be used concurrently with Zevaskyn

Policy consequenceConcurrent use is explicitly prohibited and may result in denial

Wound-level noteAgents will not be used on wounds treated with the other named products

Zevaskyn — identity & use summary

Product identityZevaskyn (prademagene zamikeracel)

Coverage conditionsCoverage requires specialist prescription/consultation, provider application, specific wound indication, and no concurrent use with specified agents

Continuation noteOngoing use must continue to meet the same conditions

OpenPayer

Pharmacologic Treatment of Epidermolysis Bullosa

Coverage Criteria

Initial Therapy Criteria

Continuation / Renewal Criteria

Provider Actions & Authorization Requirements

Step Therapy / Prior Treatments

Application / Site of Care Requirements

Definitions & Key Terms

Background