Payer PolicyActive
Agalsidase Beta (Fabrazyme)
EVICORE-MEDICAL_DRUG-7969FFCE
EviCore by Evernorth
Effective: September 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Fabrazyme (agalsidase beta) is covered only for the FDA‑approved indication of Fabry disease (other indications excluded) for up to 12 months at a dose up to 1 mg/kg IV no more frequently than every 2 weeks. Approval requires documentation of deficient α‑galactosidase A activity in leukocytes or fibroblasts OR a pathogenic GLA (α‑galactosidase A) gene mutation, prescription by or consultation with a geneticist, endocrinologist, metabolic disorder or lysosomal storage disorder specialist, and supporting clinical records.
Coverage Criteria Preview
Key requirements from the full policy
"Fabrazyme (agalsidase beta) is indicated for the treatment of individuals with Fabry disease."
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