Afamelanotide (Scenesse)

Scenesse (afamelanotide) is covered to increase pain‑free light exposure in adults with erythropoietic protoporphyria (including X‑linked protoporphyria) when all criteria are met; use for other diagnoses or without meeting required criteria is not covered. Required documentation includes diagnostic confirmation by elevated free erythrocyte protoporphyrin or molecular genetic testing, history of ≥1 porphyric phototoxic reaction, age ≥18, prescription by or in consultation with a dermatologist, gastroenterologist, hepatologist, or porphyria specialist, with a single subcutaneous implant every 2 months and authorization limited to 12 months.

"Scenesse is indicated to increase pain free light exposure in adult patients with a history of phototoxic reactions from erythropoietic protoporphyria (EPP)."

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