Payer PolicyActive
Onpattro™ (patisiran)
EVICORE-MEDICAL_DRUG-17C0F430
EviCore by Evernorth
Effective: October 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Onpattro (patisiran) is covered only for the FDA‑approved indication of treating polyneuropathy from hereditary transthyretin‑mediated amyloidosis (hATTR) in adults; uses outside this indication are excluded. Approval (up to 12 months) requires genetic confirmation of hATTR, documentation of symptomatic polyneuropathy, age ≥18, prescription by or consultation with a neurologist/geneticist/amyloidosis specialist, weight documentation for IV dosing every 3 weeks (0.3 mg/kg if <100 kg; 30 mg if ≥100 kg), and a treatment plan/dosing schedule.
Coverage Criteria Preview
Key requirements from the full policy
"Onpattro is indicated for the treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults."
Sign up to see full coverage criteria, indications, and limitations.