Hyftor (sirolimus topical gel) — Point32Health

Initial criteria

• Documented diagnosis of facial angiofibroma associated with tuberous sclerosis
• Patient age ≥ 6 years
• Prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Documentation that the patient has shown improvement on the requested medication

Approval duration

initial 4 months; reauth 12 months