| Kaiser Foundation Health Plan Southern California |
| Lumizyme (alglucosidase alfa) |
| Drugs for Metabolic Disease : Drugs for Metabolic Disease |
- Prior Authorization: Duchenne Muscular Dystrophy (DMD):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 4
Duration: 6 Month(s)
Reauthorization Required: Yes
- Step Therapy: ST Applies
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