Multiple Sclerosis Therapy - Gilenya
||All FDA-approved indications not otherwise excluded from Part D.
||Concurrent use of Gilenya with other disease-modifying agents used for multiple sclerosis (MS).
|Required Medical Information:
||For use in MS, patient has a relapsing form of MS.
||Prescribed by, or in consultation with, a neurologist or an MS specialist.
||Authorization will be for 12 months.
||For use in a relapsing form of MS, approve if patient meets one of the following: 1) Patient is currently taking or has a history of use with fingolimod (Gilenya), dimethyl fumarate (Tecfidera), or teriflunomide (Aubagio), OR 2) Patient is unable to administer injections due to dexterity issues or visual impairment, OR 3) Patient has tried one of the following injectables: interferon beta-1a intramuscular (Avonex), interferon beta-1a subcutaneous (Rebif), interferon beta-1b (Betaseron or Extavia), glatiramer acetate (Copaxone). If the patient has not yet tried an injectable, the patient must try one of Avonex, Rebif, Betaseron, or Copaxone 20 mg.
Last Modified on 11/14/2014