Laronidase (Aldurazyme®) is used to treat mucopolysaccharidosis I (MPS I), an autosomal recessive disorder which causes a deficiency of alpha-L-iduronidase, an enzyme required to break down glycosaminoglycans.
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.
Laronidase (Aldurazyme) may be considered medically necessary for individuals with the following:
Diagnosis of ANY ONE of the following forms of mucopolysaccharidosis type I:
- Hurler; or
- Hurler-Scheie; or
- Scheie form with moderate to severe symptoms.
The use of laronidase (Aldurazyme) is considered experimental/investigational and therefore are non-covered for all other indications. Scientific evidence does not support the use of laronidase (Aldurazyme) for any other indication.