Payer PolicyActive
Amvuttra™ (vutrisiran)
EVICORE-MEDICAL_DRUG-7A69CC6E
EviCore by Evernorth
Effective: October 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Amvuttra (vutrisiran) is covered only for adult (≥18) patients for the polyneuropathy of hereditary transthyretin‑mediated amyloidosis and is not covered for other indications or for patients with a history of liver transplantation. Approval (up to 12 months) requires documented TTR gene mutation, clinical evidence of symptomatic polyneuropathy, prescription by or consultation with a neurologist/geneticist/amyloidosis specialist, and follows the recommended dosing of 25 mg subcutaneously every 3 months with supporting documentation.
Coverage Criteria Preview
Key requirements from the full policy
"Amvuttra is indicated for the treatment of the polyneuropathy of hereditary transthyretinmediated amyloidosis in adults."
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