Collagenase Clostridium Histolyticum (Xiaflex)

Xiaflex is covered for Dupuytren’s contracture with a palpable cord and for adult men with Peyronie’s disease with a palpable penile plaque and ≥30° curvature, and is excluded for plaques involving the penile urethra or for patients with hypersensitivity to collagenase (avoid injection into tendons, nerves, vessels, urethra). Coverage requires objective documentation (palpable cord and MCP/PIP contracture for Dupuytren’s; baseline measured curvature ≥30° and penile modeling for Peyronie’s), no more than 3 injections per Dupuytren’s cord at ≥4‑week intervals (16‑week approval), up to four ~6‑week treatment cycles per Peyronie’s plaque with discontinuation if curvature <15°, plus Xiaflex REMS prescriber/site certification and safety/anticoagulant precautions.

"Treatment of individuals with Dupuytren's contracture with a palpable cord."

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