Procysbi — CareFirst (Caremark)

Initial criteria

• Diagnosis of cystinosis confirmed by increased cystine concentration in leukocytes or by genetic testing
• Member age ≥ 1 year
• Procysbi will not be used in combination with Cystagon
• Prescribed by or in consultation with a physician who specializes in the treatment of metabolic disease and/or lysosomal storage disorders

Reauthorization criteria

• Member is responding to therapy (e.g., improvement, stabilization, or slowing of disease progression for serum creatinine, calculated creatinine clearance, leukocyte cystine concentration, or maintained growth [height])

Approval duration

12 months