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 will be applied in a surgical health care setting in a qualified wound center by a provider with expertise in wound care in Recessive Dystrophic Epidermolysis Bullosa (RDEB)

P & T Revisions

2025-08-21, 2025-07-07

References

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

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Revision History

• 2025-08-21: Update following P&T feedback for criterion 3 to ensure appropriate use.
• 2025-07-07: New Program.

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