Payer PolicyActive
Vutrisiran (Amvuttra™)
EVICORE-MEDICAL_DRUG-1CCD13F3
EviCore by Evernorth
Effective: November 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Amvuttra (vutrisiran) is covered for treatment of polyneuropathy of hereditary transthyretin‑mediated amyloidosis in adults and is excluded for non–FDA‑approved uses and for patients with a history of liver transplantation. Approval (up to 12 months) requires genetic confirmation of hATTR, documented symptomatic polyneuropathy (history/clinical exam or EMG/NCV), age ≥18, prescription by or in consultation with a neurologist/geneticist/amyloidosis specialist, and dosing per label 25 mg subcutaneously every 3 months.
Coverage Criteria Preview
Key requirements from the full policy
"Amvuttra is indicated for the treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults."
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