Inotersen (Tegsedi) — Clinical Policy
Defines medical necessity, authorization, and clinical criteria for coverage of inotersen (Tegsedi) for treatment of hereditary transthyretin-mediated amyloidosis with polyneuropathy for affected commercial, Medicaid, HIM/ICHRA members.
Appendix D: Manufacturer will discontinue commercial availability of Tegsedi effective September 27, 2024.
Wainua was added to the list of drugs that should not have been previously received or prescribed concurrently (later removed in 2Q 2025).
For Medicaid/HIM/ICHRA initial approval duration revised to 12 months (previously 6 months).
For Medicaid/HIM revised initial approval duration from 6 to 12 months.
Removed requirement that member has not received prior treatment with Amvuttra, Onpattro, or Wainua.
Added active HCPCS codes [C9399] and [J3490].
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.