vosoritide — CareFirst (Caremark)

Initial criteria

• Diagnosis of achondroplasia confirmed by EITHER: (a) symptoms (short stature with marked shortening of extremities due to rhizomelia, characteristic facial configuration, trident hand) AND X-ray findings consistent with achondroplasia OR (b) genetic testing for FGFR3 mutation
• Epiphyses are open
• Medication prescribed by or in consultation with an endocrinologist, pediatric endocrinologist, geneticist, or neurologist

Reauthorization criteria

• Member meets all initial coverage requirements
• Member is experiencing benefit from therapy (e.g., improvement or stabilization of annualized growth velocity [centimeters per year] from baseline)

Approval duration

12 months