Description: Laronidase injection
Unit: 0.1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 0.58mg/kg IV every 1 week
Calculate drug reimbursement
(ASP: $16,387.95, Margin: $983.28)
# Units to bill:464
Prior auth criteria for Aldurazyme may include but is not limited to:
1. The patient must have been diagnosed with mucopolysaccharidosis type I (MPS I), a rare genetic disorder caused by a deficiency in the enzyme alpha-L-Iduronidase (IDUA).
2. The patient must have a confirmed diagnosis of MPS I based on clinical signs and symptoms, and laboratory tests.
3. The patient must be aged 2 years or older.
4. The patient must have failed to respond to an adequate trial of an alternative therapy, or have an intolerance to the alternative therapy.
5. The patient must be able to receive and metabolize Aldurazyme.
6. The patient must have documentation of informed consent prior to initiation of therapy.
Insurance prior auth guidelines:
Aldurazyme (GENZYME CORPORATION)