MedicaidPrior AuthMedium impact
Prior Authorization of Spinraza (nusinersen) – Pharmacy Services MAB 01-17-27
Pennsylvania Medicaid (DHS)·PA · Neurology, Pediatrics·Prior Authorization
Effective date
Jun 6, 2017
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Spinraza (nusinersen) prescriptions effective June 6, 2017. Prescriptions must be written by or in consultation with a neurologist experienced in treating spinal muscular atrophy and meet specific clinical criteria including genetic testing confirmation and baseline motor function assessments.
Action Required
Immediately: Update billing system to flag all Spinraza (nusinersen) prescriptions for prior authorization requirement for Pennsylvania Medicaid patients. Notify providers that prescriptions must be written by or in consultation with an SMA-experienced neurologist and include documentation of SMA diagnosis with SMN gene mutation, baseline motor function assessment, and platelet count. Claims will be denied without proper prior authorization.