Evrysdi (risdiplam)
Defines prior authorization, coverage criteria, continuation criteria, dosing limits, specialty pharmacy requirement, and quantity limits for Evrysdi (risdiplam) under the commercial/pharmacy benefit.
Updated initial criteria to remove requirement that member is at least 2 years and less than 25 years of age at initiation; required prescription by or in consultation with an SMA-specialist neurologist; included dosing for members less than 2 months of age.
Added quantity limit for Evrysdi tablet (30 tablets per 30 days).
Also added quantity limit for Evrysdi tablet.