Xiaflex (collagenase clostridium histolyticum) — Point32Health

Initial criteria

• Documented diagnosis of Dupuytren’s contracture
• Documentation of a finger flexion contracture with a palpable cord in a metacarpophalangeal joint or a proximal interphalangeal joint prior to initiating Xiaflex therapy
• Prescribed by or in consultation with a hand surgeon, plastic surgeon, orthopedic surgeon, or rheumatologist
• Documentation the contracture is at least 20 degrees prior to initiating Xiaflex therapy
• Documentation that the flexion deformity results in functional limitations
• Patient age ≥ 18 years
• Documentation the patient will receive a maximum of three (3) injections per cord at an interval of four (4) weeks