Payer PolicyActive
Casimersen Intravenous Infusion (Amondys 45®)
EVICORE-MEDICAL_DRUG-B6D9751F
EviCore by Evernorth
Effective: October 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Amondys 45 (casimersen IV) is FDA‑accelerated approved for Duchenne muscular dystrophy in patients with a confirmed DMD mutation amenable to exon 45 skipping, but this policy does not recommend approval/coverage because clinical benefit has not been established. Continued FDA approval requires confirmatory trials verifying clinical benefit, and the policy specifies no additional documentation or medical‑record requirements.
Coverage Criteria Preview
Key requirements from the full policy
"Amondys 45 is indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 45 skipping. This indication is app..."
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