Payer PolicyActive
Vestronidase Alfa-vjbk Injection (MEPSEVII® )
EVICORE-MEDICAL_DRUG-298637EC
EviCore by Evernorth
Effective: July 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only for the FDA‑approved indication mucopolysaccharidosis type VII (MPS VII; Sly syndrome); non‑FDA uses are excluded. Requires documentation of deficient beta‑glucuronidase activity (in leukocytes, fibroblasts, or serum) or a GUSB gene mutation and prescription/consultation by a geneticist, endocrinologist, metabolic/lysosomal storage disorder specialist, with dosing 4 mg/kg IV every 2 weeks and approvals limited to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Mepsevii is indicated for the treatment of individuals with mucopolysaccharidosis type VII (MPS VII; Sly syndrome)."
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