The agency that told provinces not to fund Spinraza for adults in July 2022 now backs it, through a reassessment route it opened itself. In 2022 its committee found no randomised evidence in treatment-naive adults and could not attribute the observational gains to the drug. At the price then submitted, adult treatment costs about C$708,000 in the first year and C$354,000 a year after that.

• Provincial drug plans: adults add years of maintenance to the budget. The draft changes no coverage on its own, and the release does not list the conditions. Any price condition will surface in the final recommendation and in the pan-Canadian Pharmaceutical Alliance negotiation that follows, and adult patients on maintenance dosing are the budget line it will be sized against.
• Sponsors with a past CDA rejection: the reassessment pilot is a second route. The 2022 rejection rested on thin, short observational data, and Muscular Dystrophy Canada credits the agency’s openness to emerging evidence for the new draft. Sponsors holding real-world data on a population the agency once turned down will test whether that openness extends to them.
• Signposts: the final text, the conditions and the provinces. Watch whether the 1 December recommendation keeps the adult and four-copy criteria, which conditions attach, including any price reduction, and how fast provinces outside Quebec list Spinraza after negotiation.