Onpattro (Patisiran)
EVICORE-MEDICAL_DRUG-4239A672
Onpattro (patisiran) is covered for the FDA‑approved indication—treatment of symptomatic polyneuropathy in adults (≥18) with genetically confirmed hereditary transthyretin‑mediated amyloidosis—for up to 12 months at IV dosing 0.3 mg/kg every 3 weeks (<100 kg) or 30 mg every 3 weeks (≥100 kg) when prescribed or consulted by a neurologist, geneticist, or amyloidosis specialist. It is not covered for pediatric patients, asymptomatic gene carriers, non‑FDA indications, or when genetic confirmation, documentation of symptomatic polyneuropathy, specialist involvement, or appropriate weight/dosing documentation are lacking.
"Is at least 18 years of age; (age restriction — pediatric use not covered by this policy)."
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