Spinraza® (Nusinersen) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Spinraza (nusinersen) for SMA only in patients with documented SMN1/chr5q mutation/deletion and excludes use for SMA without chr5q mutations or for concomitant chronic SMN‑modifying therapy (e.g., risdiplam). Coverage requires diagnosis by/with a neurologist experienced in SMA, documentation of the mutation, patient not dependent on invasive ventilation (and not using non‑invasive ventilation beyond naps/night), baseline motor assessments (except <2 months), intrathecal administration by experienced clinicians and dosing per FDA labeling (initial ≤4 loading doses; reauth ≤3 maintenance doses/12 months; prior gene‑therapy recipients need documented clinical decline).

"Laboratory values describing the type of mutation or deletion of genes in chromosome 5q (documentation of SMN1 mutation/deletion or compound heterozygous mutation)."

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