{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:09:23Z","timestamp":1780549763225,"version":"3.54.1"},"reference-count":45,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Muscular Dystrophy Association & Sarepta Therapeutics"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuromuscular Diseases"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To examine initial and reauthorization coverage policies for therapies targeting five NMDs\u2014Duchenne muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, generalized myasthenia gravis, and Lambert-Eaton myasthenic syndrome\u2014across all U.S. state Medicaid programs and leading commercial health plans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Many plans lacked publicly accessible policies, and most covered therapies were subject to restrictive requirements. These barriers\u2014such as step therapy, narrow prescriber criteria, and short approval periods\u2014may delay treatment and disrupt care continuity. Findings underscore the need for greater transparency and reform in prior authorization and pharmacy benefit design to support timely access to NMD therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/22143602251405815","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T16:15:31Z","timestamp":1765296931000},"page":"436-444","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["U.S. health plan coverage of Neuromuscular Disease Therapies: An assessment of policy availability and restrictions"],"prefix":"10.1177","volume":"13","author":[{"given":"A Alex","family":"Levine","sequence":"first","affiliation":[{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia A","family":"Rucker","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Cockerham","sequence":"additional","affiliation":[{"name":"Sarepta Therapeutics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Cartner","sequence":"additional","affiliation":[{"name":"Muscular Dystrophy Association, Inc."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D","family":"Chambers","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Health Policy Studies, Tufts Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Deenen JC Horlings CG Verschuuren JJ et al. The epidemiology of neuromuscular disorders: a comprehensive overview of the literature. J Neuromuscul Dis 2015; 2: 73-85.","DOI":"10.3233\/JND-140045"},{"key":"e_1_3_2_3_2","first-page":"1","article-title":"Advances in neuromuscular disease bring more precise diagnoses and expanded treatments","volume":"22","author":"Fitzgerald S","year":"2022","unstructured":"Fitzgerald S. Advances in neuromuscular disease bring more precise diagnoses and expanded treatments. Neurology Today 2022; 22: 1\u201312.","journal-title":"Neurology Today"},{"key":"e_1_3_2_4_2","unstructured":"U.S. Food and Drug Administration. Fast Track Breakthrough Therapy Accelerated Approval Priority Review. 2023; https:\/\/www.fda.gov\/patients\/learn-about-drug-and-device-approvals\/fast-track-breakthrough-therapy-accelerated-approval-priority-review. Accessed November 16 2023."},{"key":"e_1_3_2_5_2","unstructured":"Fischer K. Who\u2019s Paying for million-dollar gene therapies? Biospace. June 11 2024. 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