nitisinone — United Healthcare

Initial criteria

• Diagnosis of hereditary tyrosinemia type 1
• AND Orfadin is being used as an adjunct to diet modification

Reauthorization criteria

• Patient shows evidence of positive clinical response (e.g., decrease in urinary/plasma succinylacetone and alpha-1-microglobulin levels) while on Orfadin therapy

Approval duration

Initial: 12 months; Reauthorization: 24 months