Zavesca (miglustat capsules - Actelion, generic) — Cigna

Initial criteria

• 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 showing 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