Burosumab-twza

Covers burosumab‑twza (Crysvita) for treatment of X‑linked hypophosphatemia (XLH) in patients ≥6 months and for FGF23‑related hypophosphatemia in tumor‑induced osteomalacia (TIO) in patients ≥2 years when diagnosis is confirmed (PHEX mutation or elevated FGF23) with fasting hypophosphatemia and relevant clinical signs and dosing is consistent with authoritative sources. Major limitations require eGFR ≥30 mL/min (not for severe renal impairment/ESRD), discontinuation of oral phosphate and active vitamin D before initiation, preference for curative tumor resection when feasible, and coverage is subject to member benefit plan rules and compendia/literature support for off‑label uses.

"Therapy is covered when proven effective for the relevant diagnosis or procedure according to generally accepted standards of practice."

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