Elapegademase-lvlr (Revcovi)

Revcovi (elapegademase‑lvlr) is covered only for FDA‑approved treatment of ADA‑SCID in pediatric and adult patients and is not authorized for off‑label uses. Coverage requires confirmation of ADA‑SCID by either bi‑allelic ADA mutations or baseline ADA catalytic activity <1%, prescription by or consultation with an immunologist/hematologist‑oncologist/ADA‑SCID specialist, authorization limited to 12 months, intramuscular administration only with a maximum weekly cumulative dose of 0.4 mg/kg, and meeting the policy’s applicable safety criteria.

"Revcovi is a recombinant adenosine deaminase indicated for the treatment of adenosine deaminase severe combined immune deficiency (ADA-SCID) in pediatric and adult patients."

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