Payer PolicyActive
Golodirsen (Vyondys 53®)
EVICORE-MEDICAL_DRUG-5C014326
EviCore by Evernorth
Effective: November 1, 2021
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Vyondys 53 (golodirsen) has FDA accelerated approval for treating Duchenne muscular dystrophy in patients with a DMD gene mutation amenable to exon 53 skipping, but Evicore does not recommend approval and the drug’s clinical benefit has not been established. Coverage requires a documented DMD diagnosis, genetic test confirming exon 53 amenability, adherence to applicable coverage and safety criteria, and continued approval may depend on confirmatory trial results.
Coverage Criteria Preview
Key requirements from the full policy
"Due to lack of clinical efficacy data, approval is not recommended for Vyondys 53."
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