Lumasiran (Oxlumo)

Oxlumo (lumasiran) is covered for treatment of primary hyperoxaluria type 1 (PH1) in pediatric and adult patients but is excluded for patients who previously received a liver transplant for PH1. Coverage requires documented AGXT mutation, at least one lab threshold (urinary oxalate ≥0.7 mmol/24h/1.73 m² OR age‑specific elevated urine oxalate:creatinine ratio OR plasma oxalate ≥20 µmol/L), prescription by or in consultation with a nephrologist/urologist, weight documentation for dosing, initial approval for 6 months (renewal 12 months), and reauthorization with objective evidence of benefit within the past 6 months.

"Initial authorization indication (all required): Patient has not previously received a liver transplant for Primary Hyperoxaluria Type 1"

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