Buphenyl — Cigna
Urea cycle disorders (UCDs) involving deficiencies of carbamylphosphate synthetase (CPS), ornithine transcarbamylase (OTC), or argininosuccinic acid synthetase (AS)
Preferred products
- generic sodium phenylbutyrate
- Pheburane
Initial criteria
- Patient meets the standard Metabolic Disorders – Phenylbutyrate Products Prior Authorization Policy criteria; AND
- Patient meets ONE of the following (i or ii):
- i. Patient has tried generic sodium phenylbutyrate; OR
- ii. Patient has tried Pheburane.
Approval duration
1 year