[
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, AmeriHealth 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.
AmeriHealth 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 AmeriHealth 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.
]