Hunter syndrome (Mucopolysaccharidosis II, MPS II) is a rare, inherited disease which can lead to premature death. Hunter syndrome is a disease in which the person's body is defective in producing the chemical iduronate-2-sulfatase, which is needed to adequately break down complex sugars produced in the body. Hunter syndrome usually becomes apparent in children one to three years of age. Symptoms include growth delay, joint stiffness, and coarsening of facial features. In severe cases, patients experience respiratory and cardiac problems, enlargement of the liver and spleen, neurological deficits, and death.
Coverage is subject to the specific terms of the member's benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the www.fepblue.org website.
Idursulfase (Elaprase) may be considered medically necessary for use in individuals five (5) years old and older with Hunter syndrome (Mucopolysaccharidosis II, MPS II).
The use of idursulfase (Elaprase) for any indication other than Hunter syndrome is considered experimental/investigational, and therefore, not covered. The safety and efficacy for any other indication has not been established.
NOTE: In addition to the above criteria, product specific dosage and/or frequency limits may apply in accordance with the U.S. Food and Drug Administration (FDA)-approved product prescribing information, national compendia, Centers for Medicare and Medicaid Services (CMS) and other peer reviewed resources or evidence-based guidelines. Blue Cross Blue Shield may deny, in full or in part, reimbursement for utilization that does not fall within the applicable dosage and/or frequency limits.