Casimersen Intravenous Infusion (Amondys 45®) - Medicaid TX

HHSC will cover casimersen (Amondys 45) for Medicaid and CHIP MCO members only to treat DMD patients with genetic confirmation of a DMD mutation amenable to exon 45 skipping (coded J3490 June 1–30, 2021 and C9075 from July 1, 2021) and it must not be used with other exon‑skipping agents or continued if physical function declines. Prior authorization requires genetic confirmation, baseline and ongoing renal monitoring (e.g., serum cystatin C, GFR, urine dipstick and urine protein‑to‑creatinine ratio), current weight dated within 30 days, and objective physical function measures; recertification requires continued renal monitoring and a recent weight.

"Amondys 45 is indicated to treat Duchenne Muscular Dystrophy (DMD) in individuals who have a confirmed mutation of the DMD gene that is amenable to exon 45 skipping."

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