Oxlumo® (Lumasiran) and Rivfloza® (Nedosiran) – Commercial Medical Benefit Drug Policyopen_in_new

Oxlumo (lumasiran) and Rivfloza (nedosiran) are covered for primary hyperoxaluria type 1 (PH1) but not when used together (combination therapy excluded) and are denied for patients post‑liver transplant. Coverage requires both metabolic (elevated urinary or plasma oxalate/glyoxylate) and AGXT genetic confirmation of PH1, prescription by or in consultation with a PH1 specialist, FDA‑label dosing, initial and renewal authorizations limited to 12 months, and for Rivfloza patients must be ≥2 years old with eGFR ≥30 mL/min/1.73 m2 and documented positive clinical response for reauthorization.

"Coverage is subject to member-specific benefit plan provisions and applicable laws; inclusion of codes or products in the policy does not guarantee reimbursement or that the service is covered unde..."

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