- The FDA's controversial approval of Sarepta Therapeutics' (NASDAQ:SRPT) eteplirsen for the treatment of Duchenne muscular dystrophy (DMD) patients amenable to exon 51 skipping has translated into a difficult path to insurance coverage.
- Humana says it will cover the $300K+ cost of therapy only for ambulatory DMD patients. Those who are wheelchair-bound or deteriorate to wheelchair status are apparently out of luck.
- Anthem (NYSE:ANTM) has declined to cover it at all because it considers eteplirsen experimental despite the OK from the FDA.
- Aetna (NYSE:AET) and Express Scripts (NASDAQ:ESRX) plan to conduct a full clinical review of the drug before deciding to cover. UnitedHealth Group (NYSE:UNH) is considering coverage with a prior authorization while Cigna (NYSE:CI) has only indicated interest in providing coverage.
Insurance coverage for Sarepta's eteplirsen a bit bumpy
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Sarepta Therapeutics, Inc. |