Onasemnogene Abeparvovec-xioi

This policy covers onasemnogene abeparvovec-xioi (Zolgensma) gene therapy for spinal muscular atrophy (SMA) in infants/children with genetically confirmed bi‑allelic SMN1 mutations. Coverage is limited to patients <2 years at infusion with documented SMN2 copy number ≤4, no advanced SMA, negative baseline anti‑AAV9 antibody titers, required baseline labs and specialist prescribing; repeat dosing, prenatal use, and concurrent or subsequent use with nusinersen or risdiplam are considered experimental and not covered.

"Illinois (Public Act 103-0458): For fully insured group or individual PPO, HMO, POS plans amended/delivered/issued/renewed on or after 2025-01-01, coverage must be provided for therapy, diagnostic ..."

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