Strensiq
Drug - Strensiq™ (asfotase alfa solution) [Alexion Pharmaceuticals, Inc.]
September 2016
Therapeutic Area - Enzyme replacement therapy
Approval criteria
- Have a diagnosis of perinatal/infantile- or juvenile-onset hypophosphatasia (HPP) AND
- Must be prescribed by an endocrinologist or a geneticist who specializes in the treatment of perinatal/infantile- and juvenile-onset hypophosphatasia (HPP) AND
- Provider’s specialty must be provided at time of request
- Must have a documented history of onset of signs/symptoms of HPP prior to being 18 years old
- Documentation of diagnosis from patient’s medical records must be provided at time of request
Quantity limit
- Dosing is based on weight. Allow a maximum of 9mg/kg per week
- Patient’s most current weight (rounded to the nearest kg) must be provided at time of request
- Provider must minimize waste (including using 2 different vial sizes if applicable)
Approvals
- Initial approval will be limited to 6 months in duration
- Renewal approval will be limited to 6 months in duration
- Renewals must be prescribed by a provider specializing in genetics and metabolism AND
- Provider’s specialty must be provided at time of request AND
- Chart notes must be supplied at time of request showing patient is responsive to treatment
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411
