Payer PolicyActive
Fabrazyme® (agalsidase beta)
EVICORE-MEDICAL_DRUG-14CED918
EviCore by Evernorth
Effective: July 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Fabrazyme (agalsidase beta) is covered only for the FDA‑approved indication of Fabry disease (all other indications excluded) and is authorized for up to 12 months. Approval requires confirmed diagnosis by either deficient alpha‑galactosidase A activity or a pathogenic GLA variant, prescription or consultation by a geneticist, endocrinologist, metabolic disorder/lysosomal storage disorder specialist, and dosing at 1 mg/kg IV every 2 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Fabrazyme (agalsidase beta) is indicated for the treatment of individuals with Fabry disease."
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