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Last Published 03.01.2026 Effective Date: 03.01.2026 This policy addresses the use of Elevidys (delandistrogene moxeparvovec-rokl) for the treatment of Duchenne muscular dystrophy (DMD)

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5-8 Recommended tests include: Vitamin B12 and methylmalonic acid Serum folate Ferritin, serum iron, and TIBC Serum or RBC magnesium 25-hydroxy vitamin D Serum zinc Whole blood thiamine or erythrocyte transketolase Vitamins A, E, and K1 in high-risk individuals Comprehensive metabolic panel for electrolyte status In complex or refractory cases, advanced micronutrient testing from functional laboratories may be warranted

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