Plasminogen, Human-tvmh (Ryplazim®)

Ryplazim is covered only for the FDA‑approved indication of plasminogen deficiency type 1 (hypoplasminogenemia); off‑label uses are excluded. Coverage requires documented biallelic PLG mutations, a baseline plasminogen activity ≤45% of normal, prescription/consultation by a hematologist, initial approval for 3 months (renewable for 12 months) with reauthorization contingent on documented clinical response or an absolute trough plasminogen activity increase ≥10% above baseline, and dosing limited to 6.6 mg/kg IV no more frequently than every other day.

"Treatment of patients with plasminogen deficiency type 1 (hypoplasminogenemia) (FDA-approved indication)."

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