Zokinvy — Medical Mutual

Initial criteria

• Patient is age ≥ 12 months
• Patient has body surface area (BSA) ≥ 0.39 m2
• Zokinvy is prescribed by or in consultation with a specialist in progeria, genetics, and/or metabolic disorders
• Patient has known causative pathogenic variant in the LMNA gene

Reauthorization criteria

• Patient is tolerating therapy
• Patient has experienced a beneficial response to therapy, as determined by the prescribing physician
• Prescribed dosage is appropriate for the patient’s BSA
• Zokinvy is prescribed by or in consultation with a specialist in progeria, genetics and/or metabolic disorders

Approval duration

1 year initial, 1 year reauth