ModifiedCignaPolicy IP0182

Spinal Muscular Atrophy - Spinraza

Cigna coverage policy for Spinraza (nusinersen intrathecal injection) detailing prior authorization requirements, clinical criteria for initial and continuation therapy, dosing/regimen and conditions not covered, and applicable billing codes.

Policy Summary

PayerCigna

PolicySpinal Muscular Atrophy - Spinraza

Policy CodePolicy IP0182

Change TypeSelected revisions (08/15/2025) and annual updates

Effective Date

Next Review Date

Key ActionPrior Authorization is required for Spinraza; approvals provided for the stated duration (initial 3 months or single maintenance dose within 4 months) and extended approvals allowed if criteria continue to be met.

POLICY UPDATE CHANGES

Policy title changed from 'Nusinersen' to 'Spinal Muscular Atrophy - Spinraza'; documentation requirements updated throughout the policy.

Initial authorization duration updated from 6 months to 3 months.

Reauthorization duration updated from 12 months to 4 months; added criteria for patients currently receiving Spinraza.

Conditions Not Covered statement updated, including concurrent use with Evrysdi.

Updated genetic testing language from 'Bi-allelic mutation' to 'bi-allelic pathogenic variants'.

Updated documentation requirements throughout the policy.

3Initial authorization duration (months)