Payer PolicyActive
Vestronidase Alfa-vjbk Injection (MEPSEVII® )
EVICORE-MEDICAL_DRUG-893C74CE
EviCore by Evernorth
Effective: August 1, 2021
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Mepsevii (vestronidase alfa‑vjbk) is covered only for the FDA‑approved treatment of mucopolysaccharidosis type VII (Sly syndrome) and is not covered for off‑label uses. Coverage requires documented confirmation by deficient beta‑glucuronidase activity (leukocytes, fibroblasts, or serum) or GUSB gene mutation, prescription or consultation with a geneticist/endocrinologist/metabolic disorder/lysosomal storage disorder specialist, dosing ≤4 mg/kg IV every 2 weeks, meeting applicable safety criteria, and is authorized for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of individuals with mucopolysaccharidosis type VII (MPS VII; Sly syndrome)."
Sign up to see full coverage criteria, indications, and limitations.