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