Payer PolicyActive
Vestronidase Alfa-vjbk Injection (MEPSEVII)
EVICORE-MEDICAL_DRUG-0681BDC5
EviCore by Evernorth
Effective: October 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Mepsevii (vestronidase alfa‑vjbk) is covered only for the FDA‑approved indication of mucopolysaccharidosis type VII (MPS VII) and is not covered for non‑FDA‑approved uses. Coverage requires lab or molecular genetic confirmation of beta‑glucuronidase deficiency, prescription or consultation by a geneticist, endocrinologist, metabolic disorder or lysosomal storage disorder specialist, documentation of dosing (up to 4 mg/kg IV no more frequently than every 2 weeks), applicable safety criteria, and approvals are granted for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Approval duration: 12 months."
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