CommercialCoverageLow impact
08.01.34d, Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)
Independence Blue Cross·Neurology, Pediatrics·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Insurance policy updated coverage and medical necessity criteria for exon skipping drugs used to treat Duchenne Muscular Dystrophy, including Eteplirsen, Golodirsen, Viltolarsen, and Casimersen. This affects pharmacy benefit coverage and reimbursement requirements for these specialty medications.
Action Required
By January 1, 2025: Review updated medical necessity criteria for DMD exon skipping drugs (Eteplirsen, Golodirsen, Viltolarsen, Casimersen) at the source URL. Update prior authorization processes and documentation requirements for these specialty medications. Ensure providers document medical necessity according to new criteria before prescribing.