Health insurer Anthem eases restrictions on Sarepta's Duchenne treatment

FILE PHOTO: The office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

NEW YORK (Reuters) - Health insurer Anthem Inc has eased access to Sarepta Therapeutics’ treatment for Duchenne muscular dystrophy, and on Thursday changed its reimbursement policy on its website to “medically necessary.”

Anthem had previously considered the drug, Exondys51, investigational and its policy required members to seek special authorization for its use before it would consider covering the costs.

The U.S. Food and Drug Administration approved Sarepta for Duchenne, a degenerative disease that mostly affects young boys, last year despite questions from experts and its own reviewers about the efficacy of the drug. The FDA asked for a further clinical trial.

An Anthem spokeswoman said its medical policy committee had reviewed information presented at recent scientific meetings, feedback from clinicians and information from Sarepta before making the change.

Sarepta Chief Executive Doug Ingram said the move was encouraging for children with the disease because it could loosen up strict policies at health insurers who have tight controls on covering the treatment. “Anthem is a very influential payer,” Ingram said.

Among the other large U.S. health insurers, Aetna Inc., Cigna Corp, and UnitedHealth Group Inc have more restrictive policies than Anthem, RW Baird analyst Brian Skorney said in a research note, while Humana Inc’s is similar. He said the Anthem change should help Sarepta sales.

“This move brings Anthem’s policy from the most restrictive of the big five, to one of the least restrictive,” Skorney wrote.

Sarepta shares were off $1.01 at $51.43 in afternoon trading with a broader decline in the Arca pharmaceutical index of 0.6 percent.

Reporting by Caroline Humer; Editing by Susan Thomas and Diane Craft