Bylvay (odevixibat) — United Healthcare

Alagille syndrome (ALGS) with moderate to severe pruritus

Initial criteria

Diagnosis of Alagille syndrome (ALGS)
Confirmation of diagnosis by presence of the JAG1 or Notch2 gene mutation
Patient has a serum bile acid concentration above the upper limit of the normal reference range for the reporting laboratory
Patient is experiencing moderate to severe pruritis associated with ALGS
Patient has had an inadequate response to at least two other conventional treatments for the symptomatic relief of pruritus (e.g., ursodeoxycholic acid, diphenhydramine, cholestyramine, rifampin, naltrexone, sertraline)
Prescribed by a gastroenterologist or hepatologist

Documentation of positive clinical response to Bylvay therapy (e.g., reduced serum bile acids, improved pruritis)
Prescribed by a gastroenterologist or hepatologist

12 months