Payer PolicyActive
Laronidase (Aldurazyme®)
EVICORE-MEDICAL_DRUG-0955803B
EviCore by Evernorth
Effective: August 1, 2021
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Aldurazyme (laronidase) is covered for Hurler, Hurler‑Scheie, and Scheie forms of MPS I (only Scheie with moderate–severe symptoms) — milder Scheie disease is not covered — with authorization for up to 12 months. Coverage requires documented deficient α‑L‑iduronidase activity or pathogenic IDUA gene mutation, prescription or consultation by a geneticist/endocrinologist/metabolic or lysosomal storage disorder specialist, and dosing limited to ≤0.58 mg/kg IV no more than once weekly with supporting clinical records.
Coverage Criteria Preview
Key requirements from the full policy
"Aldurazyme (laronidase) is indicated for the treatment of individuals with the Hurler or Hurler-Scheie forms of mucopolysaccharidosis type I."
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