dalfampridine — CareFirst (Caremark)
Treatment to improve walking in adult patients with multiple sclerosis demonstrated by an increase in walking speed
Initial criteria
- Diagnosis of multiple sclerosis
- Member has sustained walking impairment prior to initiating therapy with the requested medication
Reauthorization criteria
- Diagnosis of multiple sclerosis
- Member has experienced an improvement in walking speed or other objective measure of walking ability since starting the requested medication
Approval duration
Initial: 30 days; Continuation: 12 months