Payer PolicyActive
Taliglucerase alfa (Elelyso)
EVICORE-MEDICAL_DRUG-05185872
EviCore by Evernorth
Effective: June 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Elelyso (taliglucerase alfa) is covered only for the FDA‑approved indication of Type 1 Gaucher disease in patients aged ≥4 years (other indications excluded), with approvals limited to 1 year. Coverage requires documented deficient β‑glucocerebrosidase activity or molecular genetic confirmation, prescription by or consultation with a geneticist/endocrinologist/metabolic or lysosomal storage disorder specialist, documentation of age/diagnosis, and dosing limited to 60 U/kg IV no more frequently than every 2 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Elelyso is indicated for the treatment of individuals with Type 1 Gaucher disease."
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