Hyftor (sirolimus) — Highmark
facial angiofibroma associated with tuberous sclerosis complex (TSC)
Initial criteria
- age ≥ 6 years
- diagnosis of tuberous sclerosis complex (ICD-10: Q85.1)
- presence of facial angiofibromas (≥ 2 mm in diameter with redness in each)
Reauthorization criteria
- prescriber attests to positive clinical response, defined as a decrease in size and/or redness of facial angiofibroma
Approval duration
initial: 3 months; reauthorization: 12 months