Anthem Blue Cross (HMO, PPO, EPO)
Lumizyme (alglucosidase alfa)
Drugs for Metabolic Disease : Drugs for Metabolic Disease
  • PA Applies
  • Prior Authorization: Pompe Disease:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

  • Pompe Disease:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Available only through Specialty Pharmacy; Limited access;
    For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE; Dosing Limit: 20 mg/kg every 2 weeks;