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Orfadin

DrugOrfadin® (nitisinone) [Rare Disease Therapeutics Inc.]

April 2015

Therapeutic area - Hereditary tyosinemia type 1

Criteria

Patient has a diagnosis of hereditary tyrosinemia type 1.

Quantity limit

180 capsules per month

Maximum dosage allowed is 2mg/kg/day. Patient’s weight must be supplied at time of request and for any renewals and dosage increases.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411

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