Collagenase clostridium histolyticum (Xiaflex)

Xiaflex is covered only for FDA‑approved uses: adults ≥18 with Dupuytren’s contracture with a palpable cord (MP or PIP joint contracture ≥20°) and adult men with Peyronie’s disease with a palpable plaque and curvature ≥30° (or ≥15° if previously treated with Xiaflex); off‑label/compendial uses are excluded. Coverage requires baseline documented measurements, provider experience (hand injection experience for Dupuytren’s; male urologic disease experience for Peyronie’s), dosing/limit rules (0.58 mg per injection, max 3 injections per cord and up to 2 cords/visit for Dupuytren’s; up to 8 total injections with ≥6 weeks between cycles for Peyronie’s and no prior complete 8‑injection course), and documentation of dosing, injection dates and prior treatment; approvals are limited to 3 months for Dupuytren’s and 6 months for Peyronie’s.

"Treatment of adult patients with Dupuytren's contracture with palpable cord."