MedicaidPrior AuthMedium impact
Prior Authorization of Exondys 51 (eteplirsen) – Pharmacy Services MAB 01-17-24
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Prior Authorization
Effective date
Jun 6, 2017
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Exondys 51 (eteplirsen) prescriptions, a medication for Duchenne muscular dystrophy. Prescriptions must be by/in consultation with an experienced neurologist and meet specific clinical criteria including baseline motor function assessments and concurrent corticosteroid therapy.
Action Required
For Pennsylvania Medicaid patients prescribed Exondys 51 (eteplirsen): Billing team must obtain prior authorization before dispensing. Ensure prescriber is neurologist experienced with Duchenne muscular dystrophy, obtain baseline motor function assessment documentation, confirm concurrent corticosteroid therapy unless contraindicated. For renewals, obtain annual evaluations and prescriber assessment of continued benefit. Claims will be denied without proper prior authorization.