Skyclarys (omaveloxolone) — CareFirst (Caremark)

Initial criteria

• Diagnosis is confirmed by detection of a variant of the FXN gene
• Member exhibits clinical manifestations of disease (e.g., muscle weakness, decline in coordination, frequent falling)
• Member is age ≥ 16 years
• Medication is prescribed by or in consultation with a physician who specializes in the treatment of Friedreich’s ataxia or a neurologist

Reauthorization criteria

• Member is experiencing benefit from therapy as evidenced by disease stability or disease improvement (e.g., improvement in speech or swallowing, upper/lower limb coordination, upright stability)

Approval duration

12 months