Xuriden (uridine triacetate) — Highmark

Initial criteria

• Diagnosis of hereditary orotic aciduria supported by one of the following:
• 1. Genetic testing confirming mutation of the UMPS gene OR
• 2. Elevated levels of orotic acid in the urine over the laboratory reference range

Reauthorization criteria

• Positive clinical response to therapy defined as one of the following:
• 1. Decreased urinary orotic acid levels from baseline OR
• 2. Stabilization or improvement of hematologic parameters (e.g., neutrophil count, neutrophil percent, white blood cell count, mean corpuscular volume) from baseline

Approval duration

12 months