Cystadane (betaine anhydrous powder – Recordati Rare Diseases, generic) — Cigna

Initial criteria

• Patient has a confirmed diagnosis based on genetic testing demonstrating one of the following: cystathionine beta-synthase deficiency OR 5,10-methylenetetrahydrofolate reductase deficiency OR cobalamin cofactor metabolism defect
• Patient has tried or is concurrently receiving vitamin B6 (pyridoxine), vitamin B12 (cobalamin), or folate supplementation
• Medication is prescribed by or in consultation with a geneticist, metabolic disease specialist, or a physician who specializes in the management of homocystinuria

Approval duration

1 year