Betaine anhydrous powder — Medical Mutual

Initial criteria

• Patient has a confirmed diagnosis based on genetic testing demonstrating one of the following (i, ii, or iii): i. Cystathionine beta-synthase deficiency; OR ii. 5,10-methylenetetrahydrofolate reductase deficiency; OR iii. Cobalamin cofactor metabolism defect
• Patient has tried or is concurrently receiving vitamin B6 (pyridoxine), vitamin B12 (cobalamin), or folate supplementation
• The medication is prescribed by or in consultation with a geneticist, metabolic disease specialist, or a physician who specializes in the management of homocystinuria

Approval duration

1 year