CommercialPrior AuthMedium impact
Laronidase (Aldurazyme®
BCBS Tennessee·TN · Genetics, Pediatrics, Internal Medicine·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee has issued a new medical policy for Laronidase (Aldurazyme®) effective 9/30/2026 that establishes coverage criteria for MPS I treatment. The policy requires prior authorization, specific diagnostic confirmation (enzyme assay or genetic testing), and ongoing documentation of clinical response for continuation therapy. This is a foundational coverage policy for a specialized rare disease treatment requiring metabolic disease specialist involvement.
Action Required
By September 30, 2026: Billing team must implement prior authorization requirements for Laronidase (Aldurazyme®) claims. (1) Configure billing system to automatically flag claims for prior auth before submission. (2) Update claim submission protocols to require: Alpha-L-iduronidase enzyme assay or genetic testing results, baseline clinical documentation of MPS I symptoms, and prescriber verification of specialization in metabolic disease/lysosomal storage disorders. (3) For continuation requests, require evidence of clinical response (improvement, stabilization, or slowing of progression) documented in chart notes. (4) Create prior auth submission checklist for front desk staff and providers outlining required documentation. (5) Train billing staff on the three qualifying MPS I forms (Hurler, Hurler-Scheie, and moderate-to-severe Scheie) and limitations (mild Scheie form and CNS manifestations are not covered). Claims submitted without proper prior authorization and documentation will be denied by BlueCross BlueShield of Tennessee.