WHA

Zokinvy (lonafarnib)

Indications for Prior Authorization

Zokinvy (lonafarnib)
  • For diagnosis of Hutchinson-Gilford Progeria Syndrome (HGPS)
    Indicated in patients 12 months of age and older with a body surface area (BSA) of 0.39 m^2 and above to reduce the risk of mortality in Hutchinson-Gilford Progeria Syndrome (HGPS).

    Limitations of Use: ZOKINVY is not indicated for other Progeroid Syndromes or processing-proficient Progeroid Laminopathies. Based upon its mechanism of action, ZOKINVY would not be expected to be effective in these populations.

  • For diagnosis of Processing-Deficient Progeroid Laminopathies
    Indicated in patients 12 months of age and older with a body surface area (BSA) of 0.39 m^2 and above for the treatment of processing-deficient Progeroid Laminopathies with either heterozygous LMNA mutation with progerin-like protein accumulation or homozygous or compound heterozygous ZMPSTE24 mutations.

    Limitations of Use: ZOKINVY is not indicated for other Progeroid Syndromes or processing-proficient Progeroid Laminopathies. Based upon its mechanism of action, ZOKINVY would not be expected to be effective in these populations.

Criteria

Zokinvy

Prior Authorization

Length of Approval: 12 Month(s)

  • One of the following:
    • Diagnosis of Hutchinson-Gilford Progeria Syndrome
      • OR
    • For treatment of processing-deficient Progeroid Laminopathies with one of the following:
      • Heterozygous LMNA mutation with progerin-like protein accumulation
      • Homozygous or compound heterozygous ZMPSTE24 mutations
    AND
  • Patient is 12 months of age or older
    • AND
  • Patient has a body surface area of 0.39 m^2 and above

  • Guideline ID
    GL-164654

  • Formulary
    EHB

  • Effective date
    Apr 1, 2025

  • P&T approval date
    Feb 18, 2021

P & T Revisions

2025-02-24, 2024-02-20, 2023-02-17, 2022-01-06, 2021-09-28, 2021-05-26, 2021-05-25, 2021-02-18

  1. Zokinvy Prescribing Information. Eiger BioPharmaceuticals, Inc. Palo Alto, CA. March 2024.
  • 2025-02-24: 2025 annual review - no criteria changes.
  • 2024-02-20: 2024 annual review: no criteria changes.
  • 2023-02-17: Annual review - no criteria changes.
  • 2022-01-06: 2022 Annual Review - No changes to clinical criteria
  • 2021-09-28: Addition of EHB formulary to guideline, no changes to criteria
  • 2021-05-26: Addition of EHB formulary to guideline, no changes to criteria
  • 2021-05-25: Addition of EHB formulary to guideline, no changes to criteria
  • 2021-02-18: New program