Payer PolicyActive
Burosumab-Twza Injection (Crysvita®)
EVICORE-MEDICAL_DRUG-D3632654
EviCore by Evernorth
Effective: May 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only for FDA‑approved X‑linked hypophosphatemia (XLH); other uses (including oncology) are excluded. Initial and 12‑month renewals require endocrinologist/nephrologist prescribing/consultation, pre‑treatment documentation of low serum phosphorus plus either low TmP/GFR or a PHEX mutation, and for adults evidence of XLH symptoms and trial of (or contraindication to) oral phosphate/calcitriol; dosing limited to ≤90 mg SC every ≥4 weeks for adults (≤90 mg SC every ≥2 weeks for pediatrics) and reauthorization requires documented clinical benefit.
Coverage Criteria Preview
Key requirements from the full policy
"Crysvita is indicated for the treatment of X-linked hypophosphatemia (XLH)."
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