Transthyretin-Mediated (ATTR) Amyloidosis (CPB 0939, reviewed 2026-08-10)

Immediately implement the following: (1) Billing team must update authorization system to require precertification for patisiran (Onpattro) IV infusion, eplontersen (Wainua) subcutaneous injection, and vutrisiran (Amvuttra) subcutaneous injection for all Aetna commercial members. Direct precertification requests to (866) 752-7021 or fax (888) 267-3277. (2) Update encounter forms and EMR templates to require specialist prescriber verification—only neurologists, geneticists, cardiologists (for Amvuttra only), or amyloidosis specialists are authorized prescribers. (3) Implement system edits to prevent concurrent use: block claims if patient is on multiple ATTR medications (patisiran + vutrisiran + eplontersen + tafamidis + acoramidis combinations). (4) For continuation of therapy claims, require documentation of clinical response using mNIS+7 score, Norfolk QoL-DN score, PND score, FAP disease stage, or manual grip strength for polyneuropathy cases; for cardiomyopathy cases, require 6-minute walk test or Kansas City Cardiomyopathy Questionnaire documentation. (5) For vutrisiran cardiomyopathy claims, verify member is not a transplant recipient and validate diagnostic criteria (biopsy-proven or technetium-labeled bone scintigraphy with light chain amyloidosis ruled out). (6) Consult Site of Care Utilization Management Policy for infusion setting requirements (Onpattro and Amvuttra). Failure to obtain precertification will result in claim denials. Billing team and providers must coordinate on all changes.