Nexviazyme (avalglucosidase alfa-ngpt) (Intravenous)
Defines prior authorization, coverage criteria, dosing, renewal rules, billing codes, and limits for Nexviazyme (avalglucosidase alfa-ngpt) for treatment of late-onset Pompe disease for Viva Health members.
No material clinical or coverage changes noted in this brief.
Coverage Summary
Coverage stance: Covered with criteria for Nexviazyme (avalglucosidase alfa-ngpt) for treatment of late-onset (non-infantile) Pompe disease. Dosing is weight-based: members ≥30 kg receive 20 mg/kg IV every two weeks and members <30 kg receive 40 mg/kg IV every two weeks. Prior authorization is required and initial authorization is valid for 12 months (365 days) with renewal possible every 12 months.
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