Payer PolicyActive
Agalsidase Beta (Fabrazyme)
EVICORE-MEDICAL_DRUG-B2D101BC
EviCore by Evernorth
Effective: January 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Fabrazyme (agalsidase beta) is covered only for the FDA‑approved indication of Fabry disease and off‑label uses are not supported. Approval requires documentation of alpha‑galactosidase A deficiency by enzyme assay or confirmatory genetic testing, adherence to applicable coverage/safety criteria (approvals for 12 months), immediate discontinuation for severe allergic/anaphylactic reactions, and recommended antipyretic/antihistamine pretreatment plus infusion-rate adjustments for infusion reactions.
Coverage Criteria Preview
Key requirements from the full policy
"Fabrazyme (agalsidase beta) is indicated for the treatment of individuals with Fabry disease."
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