Fosdenopterin (Nulibry®)

Nulibry (fosdenopterin) is covered only to reduce mortality in FDA‑approved molybdenum cofactor deficiency (MoCD) Type A and is not covered for other diagnoses or other MoCD types. Coverage requires documented MOCS1 mutation, clinical documentation that the disease is not too advanced and the patient is expected to benefit, prescription by or consultation with a pediatrician, geneticist, or MoCD specialist, IV administration up to 0.9 mg/kg once daily, and authorization is limited to 12 months (with corresponding genetic, clinical, prescriber, and dosing documentation).

"Genetic testing confirmations of a mutation in the MOCS1 gene (test results)."

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