Medical benefit pharmaceutical policies for providers
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MBP 198.0 Gamifant (emapalumab-lzsg)
Gamifant (emapalumab-lzsg) is an interferon gamma (IFNγ) blocking monoclonal antibody. IFNγ is hypersecreted in hemophagocytic lymphohistiocytosis (HLH); emapalumab binds to IFNγ and neutralizes it.
MBP 211.0 Givlaari (givosiran)
Givlaari (givosiran) is a double-stranded small interfering RNA that causes degradation of aminolevulinate synthase 1 (ALAS1) mRNA in hepatocytes through RNA interference, reducing the elevated levels of liver ALAS1 mRNA. The reduction of ALAS1 mRNA decreases circulating levels of neurotoxic intermediates aminolevulinic acid (ALA) and porphobilinogen (PBG), which are factors associated with attacks and other disease manifestations of acute hepatic porphyria (AHP).
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