Vol. 6 No. 2 (2026)
Reimbursement Recommendations

Pegunigalsidase Alfa (Elfabrio)

decorative image of the issue cover

Published February 23, 2026

Key Messages

  • Canada’s Drug Agency (CDA-AMC) recommends that Elfabrio should be reimbursed by public drug plans for the treatment of Fabry disease (FD) if certain conditions are met.
  • Elfabrio should only be covered to treat patients based on the criteria used by each of the public drug plans for reimbursement of enzyme replacement therapies (ERTs) (i.e., agalsidase beta and agalsidase alfa) for FD.
  • Elfabrio should only be reimbursed in patients under the care of a clinician experienced in the diagnosis and management of FD and should not be reimbursed when combined with other ERTs or oral chaperone therapy for FD. The total cost of Elfabrio should not exceed the total cost of the least costly comparator treatment for FD.