Elosulfase alfa (Vimizim®)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

  • Treatment of patient with mucopolysaccharidosis type IVA (Morquio A syndrome)

Patients must meet the following criteria for the indications above:

  • Patients must have Morquio A syndrome, a genetic lysosomal storage disorder

This Medication is Not Approvable for the following condition(s):

  • Any condition not listed above.

Dosing:

  • Administer 2 mg/kg intravenously once weekly
  • Administer over 3.5 to 4.5 hours

Approval Period:

One year


 

Last review date: May 5, 2014