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Home / Member / Medicare Members / MedSupp PA Multiple Sclerosis Therapy

Multiple Sclerosis Therapy

Covered Uses: All FDA-approved indications not otherwise excluded from Part D. Additional off-label coverage is provided for treatment at the time of a first demyelinating event.
Exclusion Criteria: Treatment of primary progressive MS is not covered. Combination therapy with a beta interferon product, Gilenya, or Copaxone is not covered.
Required Medical Information: For relapsing forms of multiple sclerosis: Patient must still either be able to walk at least a few steps or alternatively must have some functional arm/ hand use consistent with performing activities of daily living.  For Rebif only, patients must be already receiving Rebif or have experienced  intolerance/failure with glatiramer (Copaxone), interferon beta-1b (Betaseron) or Interferon beta-1a (Avonex).
Age Restrictions:  
Prescriber Restrictions:  
Coverage Duration: 12 months
Other Criteria:  

 

Last Modified on 12/19/2012
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