Veopoz (pozelimab-bbfg)
Indications for Prior Authorization
Veopoz (pozelimab-bbfg)
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For diagnosis of CD55-deficient protein-losing enteropathy (PLE)
Indicated for the treatment of adult and pediatric patients 1 year of age and older with CD55-deficient protein-losing enteropathy (PLE), also known as CHAPLE disease.
Criteria
Veopoz
Prior Authorization (Initial Authorization)
Length of Approval: 12 Month(s)
- Diagnosis of active CD55-deficient protein-losing enteropathy (PLE), also known as CHAPLE disease AND
- Patient has a confirmed genotype of biallelic CD55 loss-of-function mutation AND
- Patient is 1 year of age or older AND
- Patient has hypoalbuminemia (serum albumin concentration of less than or equal to 3.2 g/dL) AND
- Patient has at least one of the following signs or symptoms within the last six months:
- abdominal pain
- diarrhea
- peripheral edema
- facial edema
- Prescribed by or in consultation with one of the following:
- Immunologist
- Geneticist
- Hematologist
- Gastroenterologist
Veopoz
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
- Patient demonstrates positive clinical response to therapy (e.g. decrease in albumin transfusions and hospitalizations, normalization of serum IgG concentrations, etc.)
P & T Revisions
2024-09-23, 2023-12-08, 2023-11-06, 2023-09-29
References
- Veopoz Prescribing Information. Regeneron Pharmaceuticals, Inc. Tarrytown, NY. March 2024.
Revision History
- 2024-09-23: 2024 UM Annual Review. Updated reauth criteria to standard "patient demonstrates positive clinical response to therapy." Background updates
- 2023-12-08: Addition of EHB formulary. No changes to criteria.
- 2023-11-06: Addition of gastroenterologist to specialist option
- 2023-09-29: New Program for Veopoz
HEALTHY LIVING