SPINRAZA (Nusinersen)

SPINRAZA (Nusinersen)

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What is SPINRAZA™?

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.

Can my child receive the SPINRAZA treatment?

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, AetnaHumanaUnited 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.

Commercial Insurance Carriers

Carrier Guidelines Effective Date
Anthem Click Here February 16, 2017
Aetna Click Here March 10, 2017
BCBS Click Here (DRAFT) February 23, 2017
Cigna TBD TBD
Coventry TBD TBD
Humana Click Here February 8, 2017
Healthsmart TBD TBD
United Healthcare Click Here April 1, 2017

 

Medicaid Insurance Carriers

Carrier Guidelines Effective Date
Amerigroup TBD TBD
Cooks Children's TBD TBD
Molina TBD TBD
Parkland TBD TBD
Superior TBD TBD
TMHP TBD TBD
Tricare TBD TBD
United Healthcare Community Plan Click Here May 1, 2017

 

If your carrier has not issued guidelines, here are two things you can do:

  1. We encourage you to contact your insurance carrier and advocate for your child. 
  2. If your insurance plan is through an employer, we also suggest you contact your employer’s HR personnel and ask them to also advocate for your child with contacts they may have at your insurance provider.

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:

  1. Contact your insurance carrier and advocate for your child. 
  2. If your insurance plan is through an employer, we also suggest you contact your employer’s HR personnel and ask them to also advocate for your child with contacts they may have at your insurance provider.

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.

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