Pharmacy Prior Authorization Criteria

Zevaskyn (prademagene zamikeracel)

Indications for Prior Authorization

Zevaskyn (prademagene zamikeracel)

• For diagnosis of Recessive Dystrophic Epidermolysis Bullosa (RDEB)
  Indicated for the treatment of wounds in adult and pediatric patients with recessive dystrophic epidermolysis bullosa (RDEB)

Criteria

Zevaskyn

Prior Authorization

Length of Approval: 1 Month(s)
For diagnosis of Recessive Dystrophic Epidermolysis Bullosa (RDEB)

• Diagnosis of Recessive Dystrophic Epidermolysis Bullosa (RDEB)
AND
• Maximum of twelve sheets are supplied for potential use
AND
• Zevaskyn is prepared by the manufacturer in an appropriate healthcare setting for surgical application by a qualified healthcare provider

P & T Revisions

2025-07-07

References

1. Zevaskyn Prescribing Information. Abeona Therapeutics Inc. Cleveland, OH. April 2025

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Revision History

• 2025-07-07: New Program.

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