Kuvan — Medica
phenylketonuria (PKU)
Initial criteria
- age ≥ 1 month
- the medication is prescribed in conjunction with a phenylalanine-restricted diet
- the medication is prescribed by or in consultation with a metabolic disease specialist (or specialist who focuses on the treatment of metabolic diseases)
Reauthorization criteria
- patient has had a clinical response according to the prescriber (examples of clinical response may include cognitive and/or behavioral improvements) OR patient has achieved a ≥ 20% reduction in blood phenylalanine concentration from pre-treatment baseline OR treatment with sapropterin has resulted in an increase in dietary phenylalanine tolerance
- patient is not receiving concomitant Palynziq (pegvaliase-pqpz subcutaneous injection) at a stable maintenance dose (concomitant use with Palynziq is permitted during Palynziq dose titration)
Approval duration
initial: 12 weeks; reauthorization: 1 year