Gattex for Short Bowel Syndrome

Effective Sept. 27, 2020, updated prior approval criteria for Gattex 10 mg/ml injection will be in place. 

Gattex Criteria for Initial Coverage (beneficiaries should meet ALL of the criteria below):

• Be one year of age or older
• Have diagnosis of short bowel syndrome
• Have been dependent on parental nutrition for at least 12 months 
• Be receiving parenteral nutrition at least three times weekly

Gattex Criteria for Continuation of Coverage:

• Beneficiary is continuing to receive parenteral nutrition while taking the requested agent.