SPINRAZA™ (nusinersen) is a prescription medicine used to treat spinal muscular atrophy (SMA) in pediatric and adult patients. The FDA has recently approved SPINRAZA and insurance carrier guidelines are still being developed among most carriers.
Children’s Health℠ is not able to administer the drug unless the patient’s carrier has established coverage guidelines. We also cannot begin the process for authorization or denial until your insurance carrier has established guidelines. For the appropriate steps, please click here.
As of today, five insurers, Anthem, Aetna, Humana, United Healthcare and Blue Cross Blue Shield, have established coverage guidelines for the SPINRAZA drug. We are awaiting guidelines from all other insurance carriers, and we are hopeful additional guidelines will be released soon. The table below provides information for each carrier.
|Anthem||Click Here||February 16, 2017|
|Aetna||Click Here||March 10, 2017|
|BCBS||Click Here (DRAFT)||February 23, 2017|
|Humana||Click Here||February 8, 2017|
|United Healthcare||Click Here||April 1, 2017|
|United Healthcare Community Plan||Click Here||May 1, 2017|
If your carrier has not issued guidelines, here are two things you can do:
If your carrier has issued guidelines and you are unsure if you meet the criteria, Children’s Health will work with your case manager and physician to submit a Letter of Medical Necessity to determine coverage and/or next steps.
If your carrier has issued guidelines and you do not meet the criteria for SPINRAZA, you may also:
We know this can be a frustrating waiting process as insurance carrier guidelines are created. Children’s Health will continue to stay updated on new information so that we can support our patient families in their steps toward receiving SPINRAZA.
If you have further questions after speaking with your insurance carrier, please contact our Managed Care team at 214-456-9642.