Anthem Won’t Cover Drug for Duchenne Muscular Dystrophy, Citing What It Feels Are Flawed Clinical Data

Anthem will not cover Exondys 51 (eteplirsen), a new treatment for Duchenne muscular dystrophy, citing the clinical trial data that FDA regulators used to approve the drug. This represents quite a setback for the drugmaker Sarepta Therapeutics, as Anthem has about 38 million covered lives. “The use of eteplirsen is considered investigational and not medically necessary for all indications, including but not limited to the treatment of Duchenne muscular dystrophy,” the company said in a statement. The drug company charges about $300,000 on a net annual basis for Exondys 51. That cost could rise, though, depending on the patient’s weight.

Sources: Anthem; Stat