Viltepso® (Viltolarsen) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Viltepso only for Duchenne muscular dystrophy patients with a DMD mutation amenable to exon‑53 skipping and expressly excludes use with other exon‑skipping agents, non–exon‑53 DMD, and other muscular dystrophies (e.g., Becker). Coverage requires a DMD‑expert neurologist, documentation of genotype and baseline ambulatory function (6MWT ≥300 m OR ambulatory without assistive device plus NSAA >17 or time‑to‑rise <7 s), FDA‑label dosing, either no prior gene therapy or documented clinically meaningful decline after gene therapy, and authorizations are limited to 12‑month intervals with reauthorization contingent on continued ambulatory status.

"OR Patient has achieved a time to rise (TTR) of less than 7 seconds"

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