Luxturna® (Voretigene Neparvovec-Rzyl) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Luxturna (voretigene neparvovec‑rzyl) for patients >12 months with genetically confirmed biallelic RPE65 mutation–associated retinal dystrophy who have sufficient viable retinal cells (OCT posterior pole area >100 μm), and excludes patients <12 months or eyes previously treated with RPE65 gene therapy. Coverage is limited to one lifetime treatment per eye, must be given by an ophthalmologist/retinal surgeon experienced in sub‑retinal injections within 45 days of approval, and requires documentation of age, genetic test results, viable retina (OCT or equivalent), prior gene‑therapy status, treatment regimen, and appropriate billing codes.

"Treatment of inherited retinal dystrophies (IRD) caused by mutations in the RPE65 gene in patients who meet all listed criteria."

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