Insurers are denying coverage for Sarepta's Elevidys, a gene therapy for Duchenne muscular dystrophy, despite its FDA approval for a broad patient population.
Coverage denials often stem from insurers aligning policies with clinical trial enrollment criteria, which focused on ambulatory patients, creating access barriers for non-ambulatory individuals.
The high cost of Elevidys, priced at $3.2 million, is a significant factor in coverage disputes, with insurers questioning the cost-effectiveness for patients with limited mobility.
Patient advocacy groups and medical professionals are pushing back against restrictive insurance policies, emphasizing the potential for Elevidys to prolong life and preserve function, even in wheelchair-bound patients.