What is Elevidys?
Elevidys is a recently FDA-approved gene therapy from Sarepta Therapeutics to treat the underlying cause of Duchenne Muscular Dystrophy (DMD). This gene therapy is approved for the treatment of ambulatory pediatric patients aged 4 and up and is a one-time treatment.
This one-time treatment is groundbreaking for the children and families affected by this genetic disorder. Children’s Health is one of a few select locations in the U.S. able to provide this gene replacement therapy.
How can a child receive this treatment?
Children’s Health is not able to administer Elevidys to patients unless their health insurer has established coverage guidelines and your insurer authorizes this treatment for your child. We typically cannot begin the process for authorization until your insurance carrier has issued guidelines. For a step-by-step guide for navigating this authorization process, please call our nurse navigators at 844-496-8200 option 1.
As of today, the below insurers have established coverage guidelines for Elevidys. We are awaiting guidelines from all other insurance carriers, and we are hopeful additional guidelines will be released soon. Please keep in mind that each individuals benefit design varies and coverage will not be determined until a benefits determination is made by the insurer.
Carrier
Guidelines
Effective Date
UHC Community Plan
4.2024
Texas Medicaid
2.2024
UHC Commercial
1.2024
Blue Cross Blue Shield (TX, NM, IL, OK)
1.2024
Cigna
12.2023
Aetna
9.2023
Superior FC
9.2023
Molina
8.2023
If your insurer has not issued guidelines, here are two things you can do:
We encourage you to contact your insurance carrier and advocate for your child to receive Elevidys
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 you are a Texas Medicaid recipient, we recommend that you call and advocate for coverage.
We know this can be a challenging 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 Elevidys.
If you have additional questions, please call our nurse navigators at 844-496-8200 option 1.