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Sarepta may gain from insurers’ re-evaluation: Cowen

March 11, 2017

Cowen sees positive trends over payor evaluation and re-evaluation of Sarepta Therapeutics Inc SRPT 0.31%’s Exondys 51, which was approved in last September for the treatment Duchenne Muscular Dystrophy.

Encouraging Trends

Analyst Ritu Baral noted that checks show that payor discussions are continuing regarding Exondys 51 with manageable, increasingly positive feedback. The analyst pointed out that, despite initial denial of coverage, it appears that Anthem has re-evaluated its decision on Exondys.

Based on Anthem’s February Specialty Pharmacy Medical Management Prior Authorization Drug List, it appears Anthem will add Exondys 51 to its prior authoration list as of May 1.

“We think this is encouraging and indicative of the evolving payor landscape surrounding Exondys 51 and more broadly, DMD,” Baral wrote in a note.

“Anthem’s pick-up, together with those such as UnitedHealth Group Inc UNH 1.17%, which started coverage on Feb. 1, support the idea of accelerating new patient starts, suggested by SRPT last week at our Healthcare Conference,” Baral continued.

Denials Persist, But Unlikely To be Permanent

That said, Baral added that coverage discussions appear to be ongoing and amenable patients are still experiencing denials.

However, the analyst highlighted that many key opinion leaders (KOLs) believe that the benefit of the drug may extend well past loss of ambulation, potentially improving respiratory and upper limb strength as well as functional activities of daily living.

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