Carbaglu (carglumic acid tablets for oral suspension) — Cigna

Initial criteria

• Diagnosis is supported by ONE of the following (i or ii):
• i. Genetic testing confirmed a mutation leading to N-acetylglutamate synthase deficiency; OR
• ii. Patient has hyperammonemia diagnosed with an ammonia level above the upper limit of the normal reference range for the reporting laboratory;
• Medication is prescribed in conjunction with a protein-restricted diet; AND
• Medication is prescribed by or in consultation with a metabolic disease specialist (or specialist who focuses on the treatment of metabolic diseases).

Approval duration

1 year if genetic testing confirmed mutation; 3 months if diagnosis based on hyperammonemia