All PlansPrior AuthLow impact
Velmanase Alfa-tycv (Lamzede®)
BCBS Tennessee·TN · Endocrinology, Pediatrics·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy establishing coverage criteria for Velmanase Alfa-tycv (Lamzede®) for treatment of non-central nervous system manifestations of alpha-mannosidosis. Prior authorization required with specific diagnostic testing, baseline functional assessments, and specialist prescriber requirements.
Action Required
Before July 31, 2026: Billing team must establish prior authorization workflows for Velmanase Alfa-tycv (Lamzede®). Create documentation checklists requiring alpha-mannosidase enzyme assay or genetic testing results, baseline functional tests (3MSCT, 6MWT, or FVC), baseline oligosaccharide levels, and specialist prescriber verification. Update systems to flag this rare disease treatment for prior auth review.