Evrysdi (risdiplam) — United Healthcare

Initial criteria

• Diagnosis of spinal muscular atrophy (SMA)
• Patient is not receiving concomitant chronic survival motor neuron (SMN) modifying therapy [e.g., Spinraza (nusinersen)]
• One of the following: (1) Patient has not previously received gene replacement therapy for the treatment of SMA [e.g., Zolgensma (onasemnogene abeparvovec-xioi)] OR (2) Both of the following: (a) Patient has previously received gene replacement therapy [e.g., Zolgensma (onasemnogene abeparvovec-xioi)] for the treatment of SMA AND (b) Submission of medical records documenting a clinically meaningful functional decline (e.g., loss of motor milestone) since receiving gene replacement therapy

Reauthorization criteria

• Documentation of positive clinical response to Evrysdi therapy
• Patient is not receiving concomitant chronic survival motor neuron (SMN) modifying therapy [e.g., Spinraza (nusinersen)]

Approval duration

12 months