Payer PolicyActive
Nexviazyme® (avalglucosidase alfa-ngpt)
EVICORE-MEDICAL_DRUG-7B60426D
EviCore by Evernorth
Effective: July 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Nexviazyme (avalglucosidase alfa‑ngpt) is covered only for the FDA‑approved treatment of late‑onset Pompe disease in patients aged ≥1 year (other indications and patients <1 year are not covered). Approval requires diagnostic confirmation by deficient acid α‑glucosidase activity or GAA gene mutation, prescribing by or consultation with a geneticist/neurologist/metabolic or lysosomal storage disorder specialist, documentation of age and weight, IV weight‑based dosing every two weeks (40 mg/kg if <30 kg; 20 mg/kg if ≥30 kg), and is authorized for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Nexviazyme (avalglucosidase alfa-ngpt) is indicated for the treatment of individuals with late-onset Pompe disease (lysosomal acid α-glucosidase deficiency)."
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