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Preferred product designated for enzyme replacement to treat Gaucher's disease

July 26, 2017

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There are various enzyme replacement products on the market to treat Gaucher?s disease, but there is no reliable evidence that demonstrates the superiority of one product over another. However, there are notable differences in cost.

Effective October 24, 2017, Independence will update Medical Policy #08.00.51: Enzyme Replacement for the Treatment of Gaucher?s Disease to designate velaglucerase alfa (VPRIV?) as the preferred enzyme replacement product for the treatment of Gaucher?s disease for commercial members who meet the medical necessity criteria for coverage, as stated in the policy.

In addition, imiglucerase (Cerezyme?) and taliglucerase alfa (Elelyso?) will be designated as non-preferred products and will only be covered as medically necessary if either of the following criteria is met:

  • The member has a documented contraindication or non-response to the preferred product (VPRIV?).
  • The member is currently receiving or has previously received a non-preferred product.

Independence will not approve requests for non-preferred products that do not meet these criteria.

Please also note the following:

  • Designating a preferred product does not affect the member?s cost-sharing for the drug.
  • Members who have current precertification approval from Independence to receive a non-preferred product are not affected by this change.

For more information

To view the Notification for the updated policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.

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