Aqneursa (levacetylleucine) — United Healthcare
neurological manifestations of Niemann-Pick disease type C (NPC)
Initial criteria
- Diagnosis of Niemann-Pick disease type C (NPC)
- Aqneursa is being used to treat neurological manifestations of NPC
- Patient is not receiving Aqneursa in combination with Miplyffa (arimoclomol)
Reauthorization criteria
- Documentation of positive clinical response to Aqneursa (e.g., slowed disease progression from baseline based on assessment with NPC–specific scales)
- Patient is not receiving Aqneursa in combination with Miplyffa (arimoclomol)
Approval duration
12 months