Voxzogo — Medical Mutual

Achondroplasia

Initial criteria

Patient is < 18 years of age; AND
The patient weighs at least 3 kg; AND
The diagnosis of achondroplasia has been confirmed by genetic testing with an identifiable mutation in the fibroblast growth factor receptor type 3 (FGFR3) gene; AND
Patient’s epiphyses are open; AND
Patient will not have limb-lengthening surgery during treatment with Voxzogo; AND
The prescriber has confirmed the patient is able to drink approximately 240 to 300 mL of fluid in the hour prior to Voxzogo administration; AND
The medication is prescribed by or in consultation with a pediatric endocrinologist

Patient is < 18 years of age; AND
The patient weighs at least 3 kg; AND
The diagnosis of achondroplasia has been confirmed by genetic testing with an identifiable mutation in the fibroblast growth factor receptor type 3 (FGFR3) gene; AND
Patient meets both of the following (a and b): a) Patient’s epiphyses are open; AND b) There is evidence of annualized growth velocity ≥ 1.5 cm/year; AND
Patient will not have limb-lengthening surgery during treatment with Voxzogo; AND
The prescriber has confirmed the patient is able to drink approximately 240 to 300 mL of fluid in the hour prior to Voxzogo administration; AND
The medication is prescribed by or in consultation with a pediatric endocrinologist; AND
Patient’s most recent annualized growth velocity continues to be above their baseline annualized growth velocity value (i.e., before the patient started on Voxzogo)

12 months