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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Neurology, GeneticsMedium impact

Duchenne Muscular Dystrophy (DMD)

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Amondys 45 (casimersen), Exondys 51 (eteplirsen), Viltepso (viltolarsen), and Vyondys 53 (golodirsen) are considered investigational for the treatment of Duchenne muscular dystrophy because there is insufficient evidence of clinical benefit. Elevidys (delandistrogene moxeparvovec-rokl) is considered not medically necessary for DMD in ambulatory individuals who have a confirmed DMD gene mutation, as there is insufficient evidence to demonstrate clinical efficacy. The 02/24/2026 review removed the investigational statement for Elevidys in non-ambulatory individuals.

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What to do

Action · 4 steps
01Requirements: Perform a formulary drug search on the patient's member ID to confirm the drug is covered under the benefit plan.
02Amondys 45, Exondys 51, Viltepso, and Vyondys 53 are considered investigational for DMD, and the investigational code reference lists HCPCS J1426 (casimersen, 10 mg), J1427 (viltolarsen, 10 mg), J1428 (eteplirsen, 10 mg), J1429 (golodirsen, 10 mg), J1413 (delandistrogene moxeparvovec-rokl, per therapeutic dose), and J3490 (unclassified drugs).
03Elevidys is considered not medically necessary for DMD in ambulatory individuals who have a confirmed DMD gene mutation.
04Services related to delivery or administration of a medication that has not been approved through the BCBSMS PA review are considered not medically necessary.

Codes mentioned

J1413J1426J1427J1428J1429J3490

Original notice

Duchenne Muscular Dystrophy (DMD)
bcbsms.com · Always check the source before changing claims.
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Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Duchenne Muscular Dystrophy (DMD)MediumNo effective date · Medical PolicyState and School Employees' Health Insurance Plan - Spravato (esketamine)HighEffective Jan 1, 2026 · Medical PolicyPulmonary Arterial HypertensionMediumEffective Oct 1, 2025 · Medical PolicyNitisinoneHighEffective Jan 1, 2026 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesNeurologyGeneticsCode J1413Code J1426Code J1427Code J1428Code J1429Code J3490

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