Study Findings from Tufts Medical Center Provide New Insights into Neuromuscular Diseases and Conditions (U.S. health plan coverage of Neuromuscular Disease Therapies: An assessment of policy availability and restrictions): Musculoskeletal Diseases and Conditions – Neuromuscular Diseases and Conditions

2025 DEC 24 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in Musculoskeletal Diseases and Conditions - Neuromuscular Diseases and Conditions. According to news reporting originating from Boston, Massachusetts, by NewsRx correspondents, research stated, “Health plan policies managing neuromuscular disease (NMD) therapies may impose burdensome requirements on patients and providers. While prior research has explored payer restrictions for rare NMD treatments, limited evidence exists on policies specifically governing therapy initiation and reauthorization.”

Financial support for this research came from Muscular Dystrophy Association & Sarepta Therapeutics.

Our news editors obtained a quote from the research from Tufts Medical Center, “To examine initial and reauthorization coverage policies for therapies targeting five NMDs-Duchenne muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, generalized myasthenia gravis, and Lambert-Eaton myasthenic syndrome-across all U.S. state Medicaid programs and leading commercial health plans. We constructed a database of coverage decisions issued by 50 states and DC Medicaid programs and 35 major commercial insurers, including both fee-for-service and managed care organizations. We analyzed (1) policy availability and coverage frequency, (2) initial coverage requirements (e.g., subgroup restrictions, step therapy, prescriber type), (3) reauthorization criteria, and (4) approval durations. Of 1204 potential decisions, 908 (75%) had publicly available policies. Of these, 558 (46%) included reauthorization criteria. Among covered therapies, 96% imposed restrictions beyond FDA label indications. Requirements varied by payer type, NMD, and therapy. Average approval durations were 6 months for initial coverage and 10 months for reauthorization. Many plans lacked publicly accessible policies, and most covered therapies were subject to restrictive requirements. These barriers-such as step therapy, narrow prescriber criteria, and short approval periods-may delay treatment and disrupt care continuity.”

According to the news editors, the research concluded: “Findings underscore the need for greater transparency and reform in prior authorization and pharmacy benefit design to support timely access to NMD therapies.”

This research has been peer-reviewed.

For more information on this research see: U.S. health plan coverage of Neuromuscular Disease Therapies: An assessment of policy availability and restrictions. Journal of Neuromuscular Diseases, 2025:22143602251405815. Journal of Neuromuscular Diseases can be contacted at: Sage Publications Inc, 2455 Teller Rd, Thousand Oaks, CA 91320, USA.

The news editors report that additional information may be obtained by contacting Julia A. Rucker, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States. Additional authors for this research include A. Alex Levine, Alex Cockerham, Joel Cartner and James D. Chambers.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1177/22143602251405815. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

Publisher contact information for the Journal of Neuromuscular Diseases is: Sage Publications Inc, 2455 Teller Rd, Thousand Oaks, CA 91320, USA.

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