Opfolda (miglustat) — United Healthcare
late-onset Pompe disease
Initial criteria
- Diagnosis of late-onset Pompe disease
- AND
- Patient has an active UnitedHealthcare medical benefit prior authorization for Pombiliti (cipaglucosidase alfa-atga) for the treatment of late-onset Pompe disease
Reauthorization criteria
- Documentation of positive clinical response to Opfolda plus Pombiliti
- AND
- Opfolda continues to be prescribed in combination with Pombiliti
Approval duration
12 months