Table 2 Payer coverage criteria for onasemnogene abeparvovec for spinal muscular atrophy
From: Patients’ access to rare neuromuscular disease therapies varies across US private insurers
Plan imposes additional coverage criteria | Covered types of SMA | Required number of copies of SMN2 gene | Age requirement | Coverage for advanced SMA* | Prescriber requirement | |
|---|---|---|---|---|---|---|
Plan 1 | Yes | NA | NA | < 2 years | No | Neurologist with expertise in SMA |
Plan 2 | Yes | 1 only | 1 or 2 copies | < 2 years | NA | NA |
Plan 3 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist |
Plan 4 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 5 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 6 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 7 | Yes | 1 only | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 8 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | NA |
Plan 9 | Yes | 1 only | 2 copies | < 9 months | No | Neurologist with expertise in SMA |
Plan 10 | Yes | 1 only | 1, 2, or 3 copies | < 2 years | No | Neurologist |
Plan 11 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 12 | Yes | 1 or 2 | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 13 | No policy | No policy | No policy | No policy | No policy | No policy |
Plan 14 | Yes | NA | 2 or 3 copies | < 2 years | NA | NA |
Plan 15 | Yes | NA | 1, 2, or 3 copies | < 2 years | No | Neurologist |
Plan 16 | Yes | NA | 1 or 2 copies | < 2 years | No | Neurologist with expertise in SMA |
Plan 17 | Yes | 1 or 2 | 1, 2, or 3 copies | < 2 years | No | Neurologist with expertise in SMA |