Medical Policy Updates

Notification of Policy Revisions Effective December 8, 2020 Posted October 1, 2020

Medical Policy Revision
Nusinersen (SpinrazaTM) "Notification" Added the following to "When Covered" section: "If the patient is asymptomatic, documentation of two or three copies of the SMN2 gene by genetic testing." Added the following to "When Covered" section: "patient will not receive concurrent treatment with risdiplam and any existing authorizations will be closed upon approval of nusinersen; and receipt of any requests for alternative drugs to treat SMA (e.g., risdiplam, onasemnogene) will result in closure of the nusinersen authorization." Added investigational statement for concomitant use of nusinersen and risdiplam. Study data from NURTURE trial added to Policy Guidelines. Added reference to 'EvrysdiTM' as a related pharmacy policy. Reference added. Medical Director review 9/2020. Policy notification given 10/1/2020 for effective date 12/8/2020.
Onasemnogene abeparvovec (Zolgensma®) "Notification" Added the following to "When Covered" section: "patient will not receive concurrent treatment with risdiplam and any existing authorizations will be closed upon approval of onasemnogene abeparvovec." Added investigational statement for concomitant use of onasemnogene abeparvovec and risdiplam. Added reference to 'EvrysdiTM' as a related pharmacy policy. Reference added. Medical Director review 9/2020. Policy notification given 10/1/2020 for effective date 12/8/2020.