Cystaran — CareFirst (Caremark)
treatment of corneal cystine crystal accumulation in patients with cystinosis
Initial criteria
- Diagnosis of cystinosis confirmed by the presence of increased cystine concentration in leukocytes or by genetic testing
- Member has corneal cystine crystal accumulation
- Medication prescribed by or in consultation with an ophthalmologist or a physician who specializes in the treatment of metabolic disease and/or lysosomal storage disorders
Reauthorization criteria
- Member is responding to therapy as evidenced by either of the following:
- • Member has experienced a decrease in corneal cystine crystal accumulation
- • Member did not experience an increase in corneal cystine crystal accumulation
Approval duration
12 months