Payer PolicyActive
Avalglucosidase alfa-ngpt_(Nexviazyme®)
EVICORE-MEDICAL_DRUG-3BB18E0B
EviCore by Evernorth
Effective: July 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Nexviazyme (avalglucosidase alfa‑ngpt) is covered only for the FDA‑approved indication of late‑onset Pompe disease in patients aged ≥1 year (other indications are not covered). Approval (up to 12 months) requires documented deficient acid α‑glucosidase activity or a pathogenic GAA gene mutation, prescribing by or consultation with a geneticist/neurologist/metabolic disorder or lysosomal storage disorder specialist, documentation of age, and dosing limited to ≤40 mg/kg IV no more often than every 2 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Nexviazyme (avalglucosidase alfa-ngpt) is indicated for the treatment of individuals with late-onset Pompe disease (lysosomal acid α‑glucosidase deficiency)."
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