Elosulfase Alfa (Vimizim)
EVICORE-MEDICAL_DRUG-1FA40335
Coverage: Vimizim (elosulfase alfa) is covered only for the FDA‑approved indication of mucopolysaccharidosis type IVA (MPS IVA/Morquio A) and is not covered for non‑FDA indications. Key requirements: approval (up to 2 mg/kg IV no more frequently than weekly for 12 months) requires documented deficient N‑acetylgalactosamine‑6‑sulfatase activity or a pathogenic GALNS gene mutation, prescribing or consultation by a geneticist/endocrinologist/metabolic‑disorder or lysosomal storage disorder specialist, and documentation of weight‑based dosing and applicable safety criteria.
"Vimizim (elosulfase alfa) is indicated for the treatment of individuals with mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome)."
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