24 insurers have policies on coverage of world's most expensive drug

Novartis said 20 commercial insurance plans and four Medicaid plans have policies in place on coverage of its gene therapy Zolgensma, the world's most expensive drug, according to BioPharma Dive. 

Seven things to know:

1. Zolgensma was approved in the U.S. May 24. It is a gene therapy for spinal muscular atrophy, an inherited muscle wasting disease that is often fatal to patients before the age of 2.

2. The drug was priced at $2.1 million, making it the world's most expensive drug. 

3. Despite some pushback from insurers, 24 plans now have coverage policies for Zolgensma, Novartis executives said on its second-quarter earnings call last week. 

4. Roughly 40 percent of commercial patients with spinal muscular atrophy who are eligible for Zolgensma are represented by the 20 plans, company executives said. 

5. Some of the coverage policies are more conservative than others, according to the report. Some policies have criteria on combination use with Biogen's Spinraza. 

6. Other plans, including Anthem and two Blue Cross Blue Shield plans, set age restrictions.

7. For patients who are represented by insurance plans without coverage policies in place, Novartis said coverage is usually granted through medical exceptions. 

Access the full report here.

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