Delandistrogene moxeparvovec-rokl

This policy covers delandistrogene moxeparvovec‑rokl (Elevidys) gene therapy infusion for treatment of Duchenne muscular dystrophy (DMD). Coverage is limited to patients with genetically confirmed DMD (male patients aged ≥4 years, with the ambulatory pediatric FDA indication for ages 4–5 and certain non‑ambulatory use under accelerated approval), requires absence of deletions in exon 8 and/or 9, baseline anti‑AAVrh74 total binding antibody titer <1:400, stable corticosteroid dosing for ≥12 weeks pre‑infusion, and is subject to member benefit plan limits, prior authorization and state‑specific provisions (use in children <4 years or without required genetic/serologic criteria is excluded).

"For Illinois fully insured group or individual PPO/HMO/POS plans amended, delivered, issued, or renewed on or after 2025-01-01: coverage for therapy, diagnostic testing, and equipment necessary to ..."