Scenesse® (Afamelanotide) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Scenesse (afamelanotide) only for adults (≥18) with erythropoietic protoporphyria (EPP) and excludes non‑EPP uses; initial and renewal authorizations are limited to up to 12 months. Approval requires documented lab or genetic confirmation of EPP (specific erythrocyte protoporphyrin criteria or FECH/ALAS2 mutation), a history of phototoxic reactions, prescription by/consultation with a hematologist or EPP specialist, administration by a manufacturer‑trained provider per FDA labeling, and supporting chart documentation (including positive response for continuation).

"Scenesse (afamelanotide) is proven and medically necessary for the treatment of erythropoietic protoporphyria (EPP) when all the following criteria are met:"

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