Endari™

Drug - Endari™ (L-glutamine oral powder) [Emmaus Medical Inc.]

February 2019

Therapeutic area - Sickle Cell Disease

Approval criteria

• Patient must be at least 5 years of age AND
• Patient has a diagnosis of sickle cell disease (SCD) AND
• Patient has 2 or more painful crises within 12 months prior to request AND
• Painful crises is defined as one of the following:
  • as a visit to an emergency room/medical facility for sickle cell-related pain which was treated with a parenterally administered narcotic or parenterally administered ketorolac OR
  • the occurrence of chest syndrome, priapism and splenic sequestration AND
• Patient must not have any ONE of the following:
  • Pregnancy
  • Lactation
  • Renal or hepatic impairment

Quantity limits

• 60 packets per 30 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411