Table 2.

Payer coverage criteria for onasemnogene abeparvovec for spinal muscular atrophy

	Plan imposes additional coverage criteria	Covered types of SMA	Required number of copies of SMN2 gene	Age requirement	Coverage for advanced SMA*	Prescriber requirement
Plan 1	Yes	NA	NA	< 2 years	No	Neurologist with expertise in SMA
Plan 2	Yes	1 only	1 or 2 copies	< 2 years	NA	NA
Plan 3	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist
Plan 4	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 5	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 6	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 7	Yes	1 only	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 8	Yes	NA	1, 2, or 3 copies	< 2 years	No	NA
Plan 9	Yes	1 only	2 copies	< 9 months	No	Neurologist with expertise in SMA
Plan 10	Yes	1 only	1, 2, or 3 copies	< 2 years	No	Neurologist
Plan 11	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 12	Yes	1 or 2	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 13	No policy	No policy	No policy	No policy	No policy	No policy
Plan 14	Yes	NA	2 or 3 copies	< 2 years	NA	NA
Plan 15	Yes	NA	1, 2, or 3 copies	< 2 years	No	Neurologist
Plan 16	Yes	NA	1 or 2 copies	< 2 years	No	Neurologist with expertise in SMA
Plan 17	Yes	1 or 2	1, 2, or 3 copies	< 2 years	No	Neurologist with expertise in SMA

NA = Payer did not address criterion in their coverage policy; *Insurers typically define advanced SMA as patients with complete paralysis of limbs, or on permanent ventilator dependence

NA not available, SMA spinal muscular atrophy, SMN survival motor neuron