Vyondys 53® (Golodirsen) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Vyondys 53 for Duchenne muscular dystrophy patients with genetic confirmation of a DMD mutation amenable to exon 53 skipping who are ambulatory by policy criteria (6MWT ≥300 m walking independently or ambulatory without assistive device plus NSAA >17 or TTR <7 s), prescribed by or in consultation with a DMD‑expert neurologist, dosed per FDA labeling, not used concomitantly with other exon‑skipping therapies, and authorized in up-to‑12‑month intervals. It is excluded/not medically necessary for non–exon‑53‑amenable DMD and other muscular dystrophies (e.g., Becker), and prior gene therapy generally precludes coverage unless records document a clinically meaningful functional decline; required documentation includes genetic test results, ambulatory testing, prescriber credentials, and dosing records.

"Treatment of Duchenne muscular dystrophy (DMD) in patients who meet ALL of the following:"