Procysbi (cysteamine bitartrate) — Highmark
nephropathic cystinosis
Preferred products
- Cystagon
Initial criteria
- age ≥ 1 year
- prescribed by or in consultation with a physician who specializes in treating nephropathic cystinosis (e.g., nephrologist)
- diagnosis of cystinosis (ICD-10: E72.04) classified as nephropathic
- experienced therapeutic failure or intolerance to plan-preferred Cystagon
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
- experienced therapeutic failure or intolerance to plan-preferred Cystagon
Approval duration
12 months