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 meets one of the following: heterozygous LMNA mutation with progerin-like protein accumulation OR homozygous or compound heterozygous ZMPSTE24 mutations

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