Zilbrysq (zilucoplan) — United Healthcare
generalized myasthenia gravis (gMG)
Initial criteria
- Diagnosis of generalized myasthenia gravis (gMG)
- Positive serologic test for anti-AChR antibodies
- Patient is not receiving Zilbrysq in combination with another complement inhibitor [e.g., Soliris (eculizumab), Ultomiris (ravulizumab-cwvz)] or a neonatal Fc receptor blocker [e.g., Rystiggo (rozanolixizumab-noli), Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)]
Reauthorization criteria
- Documentation of positive clinical response to Zilbrysq therapy
- Patient is not receiving Zilbrysq in combination with another complement inhibitor [e.g., Soliris (eculizumab), Ultomiris (ravulizumab-cwvz)] or a neonatal Fc receptor blocker [e.g., Rystiggo (rozanolixizumab-noli), Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)]
Approval duration
12 months