Nityr — Highmark
Hereditary tyrosinemia type 1 (HT-1)
Initial criteria
- Diagnosis of HT-1 confirmed by biochemical and/or genetic testing
- Prescriber attests that the member is following a diet restricted in tyrosine and phenylalanine
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months