TX Medicaid Amondys 45 (casimersen)

HHSC covers Amondys 45 (casimersen) for Medicaid and CHIP enrollees with DMD whose DMD gene mutation is confirmed amenable to exon 45 skipping, excludes concomitant use with other exon‑skipping therapies and continuation if physical function declines (HCPCS J3490 covered 6/1–6/30/2021, C9075 from 7/1/2021). Prior authorization is required with genetic confirmation, baseline and ongoing renal monitoring (serum cystatin C, urine dipstick, urine protein:creatinine, GFR), current weight dated ≤30 days, baseline functional assessment (e.g., 6MWT, North Star, Brooke) and periodic recertification with continued renal monitoring.

"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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