Amondys 45® (Casimersen) – Commercial Medical Benefit Drug Policyopen_in_new

This policy covers Amondys 45 (casimersen) for the treatment of Duchenne muscular dystrophy in patients with a DMD gene mutation confirmed to be amenable to exon 45 skipping and when prescribed by or in consultation with a neurologist experienced in DMD. Coverage requires documented baseline functional criteria (ambulatory without an assistive device with pre-treatment thresholds such as a 6‑minute walk test ≥300 m or NSAA >17 and time‑to‑rise <7 s), dosing per FDA labeling, no concurrent exon‑skipping therapies, prior gene therapy only if records show clinically meaningful decline, and initial/renewal authorizations limited to up to 12 months.

"Dosing is in accordance with the United States Food and Drug Administration approved labeling"

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