Payer PolicyActive
Vimizim® (elosulfase alfa)
EVICORE-MEDICAL_DRUG-4D2F9D89
EviCore by Evernorth
Effective: June 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Vimizim (elosulfase alfa) is covered for treatment of mucopolysaccharidosis type IVA (MPS IVA; Morquio A) and is not supported/covered for other diagnoses. Approval is for 12 months at the recommended dose 2 mg/kg IV once weekly (infused over 3.5–4.5 hours) and requires diagnostic confirmation by deficient N‑acetylgalactosamine‑6‑sulfatase activity or GALNS genetic testing, prescription by or consultation with a geneticist/endocrinologist/metabolic disorder or lysosomal storage disorder specialist, and documentation of applicable safety criteria.
Coverage Criteria Preview
Key requirements from the full policy
"Vimizim (elosulfase alfa) is indicated for the treatment of individuals with mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome)."
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