CurrentUnitedHealthcarePolicy 2026 P 2355-4
Aqneursa™ (levacetylleucine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Defines UnitedHealthcare Commercial Plans' prior authorization and medical necessity criteria for initial and reauthorization coverage of Aqneursa (levacetylleucine) for treatment of neurological manifestations of Niemann-Pick disease type C (NPC). Includes eligibility, concomitant therapy restrictions, prescriber requirements, and authorization duration.
Policy Summary
PayerUnitedHealthcare
PolicyAqneursa™ (levacetylleucine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Policy CodePolicy 2026 P 2355-4
Change TypeNew program; added concomitant therapy and miglustat criteria
Effective DateApr 1, 2026
Next Review Date
Key ActionObtain prior authorization by documenting genetic confirmation of NPC and prescriber expertise; approvals issued for 12 months.
SourceLink
POLICY UPDATE CHANGES
New program created for Prior Authorization/Medical Necessity - Aqneursa (levacetylleucine).
Added criterion that Aqneursa not taken in combination with Miplyffa (arimoclomol).
Added criterion that Aqneursa be taken in combination with miglustat or there is history of failure, contraindication, or intolerance to miglustat.
Annual review without changes to coverage criteria.
1Covered Indication (NPC)
12 moAuthorization duration
≥15 kgMinimum patient weight