Health Net
Exondys 51 (eteplirsen)
Drugs for Nerves and Muscles : Drugs for Nerves and Muscles
  • Step Therapy: Duchenne Muscular Dystrophy (DMD):
    ST Single Generic

  • Duchenne Muscular Dystrophy (DMD):
    Age Requirement: <= 13
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 6 month(s)
    Specialty Pharmacy is Required: Not Defined

  • Prior Authorization: Duchenne Muscular Dystrophy (DMD):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: <= 13
    Duration: 6 Month(s)
    Reauthorization Required: Yes

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