Sanofi Genzyme is committed to working with healthcare providers, as well as with public and private payers, to help secure access to treatment for patients who may benefit from Lumizyme® (alglucosidase alfa).
Treatment with Lumizyme is a covered benefit under most major insurance plans, as well as Medicare and Medicaid. In this section, you will find an overview of Lumizyme coverage under different kinds of insurers, information on potential requirements, and other issues to consider when reviewing your patients' plans.
The information provided here is not comprehensive and is subject to change. Providers ultimately retain responsibility for determining reimbursement and insurance issues related to their patients, so it's important for you to understand the details of your patients' specific coverage and benefits. Sanofi Genzyme is not responsible for failure of a provider to obtain reimbursement.
In addition to the reimbursement expertise provided to patients by CareConnectPSS® Case Managers, Sanofi Genzyme also offers the following downloadable resources to help guide the process.
Lumizyme Billing Guide
To bill for Lumizyme therapy, you must use the appropriate codes. The billing procedures may vary according to the site of service or third-party payer guidelines. Please reference this billing guide.
Letter of Intent to Treat
The Letter of Intent (LOI) is a template for you to complete indicating intent to treat a patient living with Pompe disease with Lumizyme. You may customize it to a patient’s specific requirements. See Lumizyme Billing Guide below.
Statement of Medical Necessity
The Statement of Medical Necessity (SMN) is a form you can use to document a patient’s clinical history of Pompe disease, diagnosis, signs and symptoms. The SMN allows you to demonstrate that Lumizyme is medically necessary for the treatment of Pompe disease in a particular patient. See Lumizyme Billing Guide below.
LUMIZYME® (alglucosidase alfa) is a hydrolytic lysosomal glycogen-specific enzyme indicated for patients with Pompe disease (GAA deficiency).
WARNING: RISK OF ANAPHYLAXIS, HYPERSENSITIVITY AND IMMUNE-MEDIATED REACTIONS, AND RISK OF CARDIORESPIRATORY FAILURE
Anaphylaxis and Hypersensitivity Reactions: Life-threatening anaphylaxis and hypersensitivity reactions have been observed in some patients during and after treatment with alglucosidase alfa. If anaphylaxis or severe hypersensitivity reactions occur, immediately discontinue infusion and institute appropriate medical treatment. Appropriate medical support and monitoring measures should be available during infusion.
Immune-Mediated Reactions: Monitor patients for the development of systemic immune-mediated reactions involving skin and other organs. If immune-mediated reactions occur, consider discontinuation of the administration of alglucosidase alfa, and initiate appropriate medical treatment.
Risk of Acute Cardiorespiratory Failure: Patients with acute underlying respiratory illness or compromised cardiac and/or respiratory function may be at risk of serious exacerbation of their cardiac or respiratory compromise during infusions. Appropriate medical support and monitoring measures should be readily available during alglucosidase alfa infusion, and some patients may require prolonged observation times that should be individualized based on the needs of the patient.
Risk of Cardiac Arrhythmia and Sudden Cardiac Death during General Anesthesia for Central Venous Catheter Placement: Administration of general anesthesia can be complicated by the presence of severe cardiac and skeletal (including respiratory) muscle weakness. Therefore, caution should be used when administering general anesthesia. Ventricular arrhythmias and bradycardia, resulting in cardiac arrest or death, or requiring cardiac resuscitation or defibrillation have been observed in infantile-onset Pompe disease patients with cardiac hypertrophy during general anesthesia for central venous catheter placement.
Risk of Antibody Development: Patients with infantile-onset Pompe disease should have a cross-reactive immunologic material (CRIM) assessment early in their disease course and be managed by a clinical specialist knowledgeable in immune tolerance induction in Pompe disease to optimize treatment. CRIM status has been shown to be associated with immunogenicity and patients’ responses to enzyme replacement therapies. There is evidence to suggest that some patients who develop high and sustained IgG antibody titers, including CRIM-negative patients, may experience reduced clinical alglucosidase alfa treatment efficacy.
Monitoring: Laboratory Tests: Patients should be monitored for IgG antibody formation every 3 months for 2 years and then annually thereafter.
The most frequently reported adverse reactions (≥ 5%) in clinical trials were hypersensitivity reactions and included: anaphylaxis, rash, pyrexia, flushing/feeling hot, urticaria, headache, hyperhidrosis, nausea, cough, decreased oxygen saturation, tachycardia, tachypnea, chest discomfort, dizziness, muscle twitching, agitation, cyanosis, erythema, hypertension/increased blood pressure, pallor, rigors, tremor, vomiting, fatigue, and myalgia.
Please see the Full Prescribing Information for complete details, including boxed WARNING.