Zavesca — Cigna
Other Conditions
Preferred products
- Cerdelga
- generic miglustat
- Yargesa
Initial criteria
- Patient meets the standard Gaucher Disease Substrate Reduction Therapy – Miglustat Prior Authorization criteria; AND
- Patient has tried ONE of Yargesa or generic miglustat capsules [documentation required]; AND
- Brand Zavesca is being requested due to a formulation difference in the inactive ingredient(s) (e.g., preservatives) between the brand and the bioequivalent generic product, which, per the prescriber, has or would result in a significant allergy or serious adverse reaction.
Approval duration
1 year