Pharmacy Prior Authorization Criteria

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.

Prior Authorization

Length of Approval: 12 Month(s)

For treatment of processing-deficient Progeroid Laminopathies with one of the following:

AND

AND

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

Zokinvy Prescribing Information. Eiger BioPharmaceuticals, Inc. Palo Alto, CA. March 2024.