Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Now in effect: Preferred product for enzyme replacement to treat Gaucher's disease

October 26, 2017

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.
Independence 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 Independence 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.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.