Zavesca (miglustat) — Highmark
neurological complications of Niemann-Pick disease type C (NPC)
Preferred products
- generic miglustat
Initial criteria
- molecularly confirmed diagnosis of Niemann-Pick disease type C (NPC)
- member experiencing neurological symptoms from NPC
- miglustat will be given in combination with Miplyffa (arimoclomol)
- if request is for brand Zavesca, therapeutic failure or intolerance to generic miglustat
Reauthorization criteria
- positive clinical response to therapy