Gilenya — CareFirst (Caremark)
clinically isolated syndrome of multiple sclerosis
Preferred products
- fingolimod (generic)
Initial criteria
- Diagnosis of a relapsing form of multiple sclerosis (including relapsing-remitting and secondary progressive disease for those who continue to experience relapse) OR diagnosis of clinically isolated syndrome of multiple sclerosis
- Medication prescribed by or in consultation with a neurologist
- Member will not use the requested medication concomitantly with other disease modifying multiple sclerosis agents (Ampyra and Nuedexta are not disease modifying)
Reauthorization criteria
- Member is experiencing disease stability or improvement while receiving the requested medication
Approval duration
12 months