Aetna joins UnitedHealth in reversing denial of $2.1M drug

Aetna reversed its coverage policy for a one-time treatment of spinal muscular atrophy weeks after UnitedHealthcare made a similar move, according to Business Insider.

Under Aetna's previous policy, the health insurer covered Novartis' drug Zolgensma, a $2.1 million, one-time treatment for spinal muscular atrophy, only for children younger than 9 months old. The new policy will include coverage for children up to 2 years old. The FDA approved the gene therapy treatment for children under 2 years of age in May. 

Aetna reversed its denial following Business Insider's reporting on families who were initially denied access to the treatment. In a statement to Business Insider, an Aetna spokesperson said: "While the data on Zolgensma is limited, emerging information, expert opinions and the promise of the medication have led us to reconsider our approach. We are broadening our coverage to fully align with the FDA-approved criteria for treatment."

The changes come weeks after UnitedHealthcare approved coverage for all six requests it received for the new drug, reversing previous denials. At the time, UnitedHealth Group's CMO, Richard Migliori, MD, told The Washington Post the coverage reversals were based on clinical evidence, not on public attention generated by the denials.

More articles on payers:
HCSC's CEO steps down: 3 things to know
HCSC CFO steps down days after CEO
UAB Health CEO on UnitedHealthcare amid dispute: Make $9B, but not on the backs of patients

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months