Gattex — Medical Mutual
Short Bowel Syndrome, Initial Therapy
Initial criteria
- Patient is age ≥ 1 year; AND
- Patient weighs at least 10 kg; AND
- Patient is dependent on parenteral support, requiring parenteral nutrition 3 or more days per week; AND
- Bilirubin, alkaline phosphatase, lipase, and amylase lab values have been assessed within the past 6 months; AND
- Medication is prescribed by or in consultation with a gastroenterologist; AND
- Prescriber has completed all REMS program requirements
Approval duration
180 days