Scenesse® (afamelanotide)

EviCore covers Scenesse (afamelanotide) only for adults (≥18) with erythropoietic protoporphyria (including X‑linked) to increase pain‑free light exposure and excludes pediatric and off‑label uses. Coverage requires documented diagnosis by elevated free erythrocyte protoporphyrin or molecular genetic testing, a history of ≥1 porphyric phototoxic reaction, prescription by or consultation with a dermatologist/gastroenterologist/hepatologist/cutaneous porphyria specialist, subcutaneous implant administration above the anterior supra‑iliac crest every 2 months, and approvals are issued for up to 12 months.

"Increase pain-free light exposure in adult patients with a history of phototoxic reactions from erythropoietic protoporphyria (EPP) (FDA‑approved indication)."

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