Payer PolicyActive
Imiglucerase (Cerezyme)
EVICORE-MEDICAL_DRUG-A845D272
EviCore by Evernorth
Effective: September 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Cerezyme (imiglucerase) is covered only for FDA‑approved Type 1 Gaucher disease and all off‑label uses are excluded. Approval (up to 1 year) requires documentation of deficient β‑glucocerebrosidase activity in leukocytes/fibroblasts or molecular genetic testing confirming a glucocerebrosidase gene mutation, prescription/consultation by a geneticist, endocrinologist, metabolic disorder or lysosomal storage disorder specialist, and dosing limited to 60 U/kg IV no more frequently than every 2 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of individuals with Type 1 Gaucher disease (FDA‑approved indication)."
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