Xiaflex® (Collagenase Clostridium Histolyticum) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Xiaflex only for Dupuytren's contracture and Peyronie's disease (not for other indications) when medical necessity criteria are met. Key requirements: age ≥18, palpable cord (Dupuytren) or plaque (Peyronie's) with documented contracture/curvature thresholds (Dupuytren initial ≥20°; continuation >5°; Peyronie's initial ≥30°; continuation ≥15°), provider experienced in the relevant specialty, FDA dosing of 0.58 mg per injection, injection limits (Dupuytren ≤3 injections per cord at ~4‑week intervals and ≤2 injections per hand; Peyronie's ≤2 injections per cycle with <4 cycles/<8 injections total), REMS-certified prescribers/sites for Peyronie's, and coverage subject to member benefit documents and applicable mandates.

"Peyronie's: Authorization is for no more than two injections and 6 weeks duration (initial and per authorization)."

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