Payer PolicyActive
Vestronidase Alfa-vjbk Injection (MEPSEVII)
EVICORE-MEDICAL_DRUG-90CEF319
EviCore by Evernorth
Effective: August 1, 2018
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
MEPSEVII (vestronidase alfa‑vjbk) is covered for pediatric and adult treatment of FDA‑approved Mucopolysaccharidosis VII (Sly syndrome) but not when used primarily to treat CNS manifestations, and no off‑label compendial uses are approved. Coverage requires confirmation by β‑glucuronidase enzyme assay or genetic testing, documentation of FDA‑approved indication, dosing at 4 mg/kg IV every 2 weeks, availability of anaphylaxis support at administration, and approvals are issued for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"MEPSEVII is indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, Sly syndrome)."
Sign up to see full coverage criteria, indications, and limitations.