CurrentUnitedHealthcarePolicy N/A

Filsuvez (birch triterpenes) topical gel prior authorization

Defines UnitedHealthcare prior authorization and medical necessity criteria for Filsuvez topical gel for treatment of dystrophic and junctional epidermolysis bullosa in patients aged 6 months and older.

Policy Summary

PayerUnitedHealthcare

PolicyFilsuvez (birch triterpenes) topical gel prior authorization

Policy CodePolicy N/A

Change TypeAnnual reviewinitial program created 4/2024

Effective Date7/1/2025

Next Review DateN/A

Key ActionObtain prior authorization with documentation confirming diagnosis/genetic mutation and wound meeting size, duration, granulation, and vascularization criteria.

SourceLink

POLICY UPDATE CHANGES

New program created for Prior Authorization/Medical Necessity - Filsuvez (birch triterpenes).

Annual review in 4/2025 with no changes to criteria; references updated.

6 monthsminimum patient age for coverage

10-50 cm2eligible wound size

>=3 weeksminimum wound duration

12 monthsauthorization period

4/2024

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