nitisinone
Drug - nitisinone (Orfadin®, Nityr®)
November 2018
Therapeutic area - Hereditary tyosinemia type 1
Approval criteria
- Patient has a diagnosis of hereditary tyrosinemia type 1 AND
- Prescriber provides documentation showing that the patient or the patient’s caregiver has been counseled on the need to maintain dietary restriction of tyrosine and phenylalanine
Quantity limit
- 2mg/kg/day
- Patient’s weight must be supplied at time of request and for any renewals and dosage increases
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411