MedicaidPrior AuthLow impact
Eteplirsen Coverage Guidelines pdf
Connecticut Medicaid (HUSKY Health)·CT · Neurology, Pediatrics·Provider Bulletin
Effective date
Jul 1, 2017
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY programs) now requires prior authorization for Eteplirsen (Exondys 51) prescriptions effective July 1, 2017. Prescribers must submit a letter of medical necessity with specific documentation including genetic testing results and 6-minute walk test scores.
Action Required
By July 1, 2017: Billing team must flag Eteplirsen (Exondys 51) prescriptions for Connecticut HUSKY program patients as requiring prior authorization. Providers must submit letter of medical necessity to Connecticut DSS Medical Director via fax (860) 424-4822 with genetic testing results and 6-minute walk test documentation. Initial authorizations are valid for 6 months only and require re-authorization.