Alglucosidase Alfa (Lumizyme)

Lumizyme (alglucosidase alfa) is covered only for the FDA‑approved treatment of Pompe disease and is not covered for any non‑FDA‑approved indications. Authorization is granted up to 12 months with dosing limited to 20 mg/kg IV no more frequently than every 2 weeks and requires diagnostic confirmation by deficient acid α‑glucosidase activity testing or molecular genetic testing and prescription by or consultation with a geneticist, neurologist, metabolic disorder subspecialist, or lysosomal storage disorder specialist.

"Treatment of individuals with Pompe disease (acid α-glucosidase deficiency) (FDA-approved indication)."

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