Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers IV ERTs (VPRIV — preferred; Cerezyme and Elelyso when VPRIV fails or causes hypersensitivity) for symptomatic Type 1 Gaucher disease and covers VPRIV (and Cerezyme if VPRIV fails/intolerant) for symptomatic Type 3, but does not support ERT for Type 2. Key requirements: confirmed diagnosis, documentation of symptomatic disease for initial approval and documented clinical response for continuation, dosing per FDA (Type 3 capped at ≤60 units/kg q2w), 12‑month authorization limits, and appropriate coding/records.

"Cerezyme, Elelyso and VPRIV are proven for the treatment of Type 1 Gaucher disease when all of the following criteria are met: For initial therapy: Diagnosis of Type 1 Gaucher disease; Symptomatic ..."

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