Spinraza® (nusinersen)

Spinraza (nusinersen) is covered for pediatric and adult SMA but is excluded for patients who have received Zolgensma and requires discontinuation of Evrysdi if previously/currently treated. Coverage requires documented bi‑allelic SMN1 pathogenic variants, SMN2 copy number of 2–3 (or 4 with symptomatic Types 1–3), a baseline motor assessment from specified scales, prescription/consultation by an SMA/neuromuscular specialist, intrathecal dosing per the 4‑loading then every‑4‑months maintenance schedule, initial approval for 3 months and 4‑month renewals only after ≥4 months from last dose with documented clinical benefit.

"Treatment of spinal muscular atrophy (SMA) in pediatric and adult patients (FDA-approved indication)."

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