Payer PolicyActive
Mepsevii® (vestronidase alfa-vjbk) Injection
EVICORE-MEDICAL_DRUG-BC0E9317
EviCore by Evernorth
Effective: June 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Mepsevii (vestronidase alfa‑vjbk) is covered only for the FDA‑approved treatment of mucopolysaccharidosis type VII (Sly syndrome) and is not covered for off‑label uses. Coverage requires confirmed diagnosis by deficient beta‑glucuronidase activity or a GUSB gene mutation, prescription by or consultation with a geneticist/endocrinologist/metabolic or lysosomal storage disorder specialist, documentation of meeting applicable safety criteria, and is approved for 12 months at the recommended dose of 4 mg/kg IV every two weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of individuals with mucopolysaccharidosis type VII (MPS VII; Sly syndrome) — FDA‑approved indication"
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