Payer PolicyActive
Taliglucerase alfa (Elelyso)
EVICORE-MEDICAL_DRUG-5D6C7B62
EviCore by Evernorth
Effective: September 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Elelyso (taliglucerase alfa) is covered only for the FDA‑approved indication of Type 1 Gaucher disease and is explicitly not authorized for other Gaucher types or any off‑label uses. Coverage requires documented deficient β‑glucocerebrosidase activity or a GBA gene mutation, prescription by or consultation with an appropriate specialist (geneticist, endocrinologist, metabolic disorder sub‑specialist, or lysosomal storage disorder specialist), dosing of 60 U/kg IV no more frequently than every 2 weeks, and authorization is limited to one year.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of individuals with Type 1 Gaucher disease (FDA‑approved indication)."
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