Cerdelga (eliglustat capsules − Genzyme) — Cigna

Initial criteria

• Patient is a cytochrome P450 2D6 extensive metabolizer, intermediate metabolizer, or poor metabolizer as detected by an approved test; AND
• Diagnosis is established by ONE of the following (i or ii): i. Demonstration of deficient beta-glucocerebrosidase activity in leukocytes or fibroblasts; OR ii. Molecular genetic test documenting biallelic pathogenic glucocerebrosidase (GBA) gene variants; AND
• Medication is prescribed by or in consultation with a geneticist, endocrinologist, metabolic disorder subspecialist, or a physician who specializes in the treatment of Gaucher disease or related disorders.

Approval duration

1 year