Payer PolicyActive
Aldurazyme® (laronidase)
EVICORE-MEDICAL_DRUG-06648B2C
EviCore by Evernorth
Effective: June 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Aldurazyme (laronidase) is covered only for FDA‑approved MPS I indications — Hurler, Hurler‑Scheie, and Scheie with moderate‑to‑severe symptoms — and non‑FDA uses are excluded. Coverage requires documented deficient α‑L‑iduronidase activity or biallelic pathogenic IDUA variants, prescription/consultation with an appropriate specialist (geneticist, endocrinologist, metabolic disorder/lysosomal storage disorder specialist), adherence to the 0.58 mg/kg IV weekly dosing, documentation of subtype/severity (for Scheie), and is authorized for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of individuals with the Hurler form of mucopolysaccharidosis type I (MPS I) (FDA-approved)."
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