Voxzogo (vosoritide) — Highmark
Achondroplasia with open epiphyses
Initial criteria
- age ≤ 17 years
- Diagnosis of achondroplasia confirmed by genetic testing for FGFR3 gene mutation (ICD-10: Q77.4)
- Prescriber provides baseline annualized growth velocity (AGV)
- Prescriber attests that epiphyses have not closed
Reauthorization criteria
- Documentation of an increase in annualized growth velocity (AGV) compared to baseline
- Prescriber attests that epiphyses have not closed
Approval duration
12 months