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Vykat XRUnited Healthcare

hyperphagia associated with Prader-Willi Syndrome

Initial criteria

  • Diagnosis of hyperphagia associated with Prader-Willi Syndrome
  • AND Prader-Willi Syndrome is confirmed by genetic testing
  • AND Patient is at least 4 years of age and older

Reauthorization criteria

  • Documentation of positive clinical response to Vykat XR therapy

Approval duration

Initial 12 months; Reauth 12 months.