Payer PolicyActive
Elaprase® (idursulfase)
EVICORE-MEDICAL_DRUG-FEDBF57A
EviCore by Evernorth
Effective: June 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Elaprase (idursulfase) is covered only for the FDA‑approved indication of mucopolysaccharidosis type II (Hunter syndrome) and is excluded for non‑FDA uses. Approval requires documented deficient iduronate‑2‑sulfatase activity or a pathogenic IDS gene mutation, prescription by or consultation with a geneticist, endocrinologist, metabolic disorder or lysosomal storage disorder specialist, is authorized for 12 months, and the recommended dose is 0.5 mg/kg IV once weekly.
Coverage Criteria Preview
Key requirements from the full policy
"Elaprase (idursulfase) is indicated for the treatment of individuals with mucopolysaccharidosis type II (MPS II; Hunter syndrome)."
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