Xiaflex (collagenase clostridium histolyticum) — Point32Health
Peyronie’s disease
Initial criteria
- Documented diagnosis of Peyronie’s disease
- Documentation of a palpable plaque
- Documentation that curvature deformity is at least 30 degrees prior to initiating Xiaflex therapy
- Prescribed by or in consultation with a urologist
- Patient age ≥ 18 years
- Documentation the patient has intact erectile function (with or without medication)
- Documentation the patient will receive a maximum of one treatment course with a maximum of 8 injections total, including any injections received for any previous treatment
Approval duration
12 months