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.
As of October 24, 2017, Medical Policy #08.00.51i: Enzyme Replacement
for the Treatment of Gaucher's Disease is in effect and has been updated to
reflect the designation of 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.
In addition, imiglucerase (Cerezyme®) and taliglucerase alfa
(Elelyso®) have been designated as non-preferred products and
are only 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:
- Member cost-sharing for the drug is not affected by the designation of a
preferred product.
- Members who have current precertification approval from AmeriHealth to
receive a non-preferred product are not affected by this change.
For more information
To review this policy, visit our Medical Policy
Portal and select Accept and Go to Medical Policy Online. Then
select the Commercial tab from the top of the page and type the policy
name or number in the Search field.