Payer PolicyActive
Imiglucerase (Cerezyme)
EVICORE-MEDICAL_DRUG-0EA56EAE
EviCore by Evernorth
Effective: July 1, 2021
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Imiglucerase (Cerezyme) is covered only for the FDA‑approved indication of Type 1 Gaucher disease and excluded for all other indications. Approval (for 1 year) requires documented deficient β‑glucocerebrosidase activity or molecular genetic confirmation, prescribing by or consultation with an appropriate specialist (geneticist, endocrinologist, metabolic disorder or lysosomal storage disorder specialist), and dosing limited to 60 U/kg IV no more frequently than every 2 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Cerezyme is indicated for the treatment of individuals with Type 1 Gaucher disease."
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