Crysvita® (Burosumab-Twza) – Commercial Medical Benefit Drug Policyopen_in_new

Crysvita (burosumab‑twza) is covered as medically necessary for X‑linked hypophosphatemia (patients ≥6 months) and for FGF23‑related hypophosphatemia in tumor‑induced osteomalacia (patients ≥2 years) when used per FDA‑labeling and the policy's diagnostic, laboratory, prescriber, prior‑therapy, and dosing criteria are met, and is not authorized if those criteria are not satisfied. Key requirements include documented diagnosis (PHEX mutation, elevated FGF23 >30 pg/mL, or specified biochemical criteria for XLH; and nonresectable/unlocalizable phosphaturic tumor for TIO), baseline fasting serum phosphorus below age‑normal, prescriber or consult by an endocrinologist/oncologist or metabolic bone specialist, prior failure/contraindication to vitamin D analog plus oral phosphate when required, FDA‑approved dosing, and authorizations limited to ≤12 months with evidence of clinical benefit for reauthorization.

"Crysvita (burosumab) is proven for the treatment of X-linked hypophosphatemia (XLH)."