Posted by Michael Wonder on 28 Oct 2016
Humana spells out its conditional Exondys 51 coverage policy — strings attached
27 October 2016 - Humana’s decision to cover Sarepta’s controversial Duchenne muscular dystrophy drug Exondys 51 (eteplirsen) comes with some thick strings attached to it.
In a new coverage policy posted at the big insurer, Humana says that it will only provide coverage for the $300,000-plus therapy provided patients are still ambulatory, continue to prove that they remain able to walk and meet the criteria for patients who may benefit from an Exon 51-skipping drug.
Under conditions for coverage, Humana notes: “The member remains ambulatory (e.g. able to walk with assistance, not wheelchair dependent).”
