Zokinvy — CareFirst (Caremark)
Hutchinson-Gilford Progeria Syndrome (HGPS)
Initial criteria
- Member is age ≥ 12 months
- Member has a body surface area ≥ 0.39 m2
- Diagnosis of Hutchinson-Gilford Progeria Syndrome is confirmed with genetic testing indicating an LMNA pathogenic variant
- Medication is prescribed by or in consultation with a physician who specializes in metabolic disease and/or lysosomal storage disorders
Reauthorization criteria
- Member meets all initial authorization criteria
- Member is experiencing benefit from therapy
Approval duration
12 months