Laronidase (Aldurazyme®)
EVICORE-MEDICAL_DRUG-756796B7
Aldurazyme (laronidase) is covered only for FDA‑approved MPS I indications (Hurler, Hurler‑Scheie, and Scheie with moderate‑to‑severe symptoms) and is not supported for non‑FDA uses. Coverage requires documented diagnostic confirmation (deficient α‑L‑iduronidase activity or pathogenic IDUA mutation), prescription by or consultation with a geneticist/endocrinologist/metabolic/lysosomal storage disorder specialist, dosing ≤0.58 mg/kg IV no more than once weekly, appropriate medical record documentation (including weight and symptom severity), and is authorized for up to 12 months per approval.
"Treatment of individuals with the Hurler or Hurler-Scheie forms of mucopolysaccharidosis type I (MPS I)."
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