Rebif (interferon beta-1a) — CareFirst (Caremark)

Initial criteria

• Member has a diagnosis of a relapsing form of multiple sclerosis including relapsing-remitting or secondary progressive disease for those who continue to experience relapse OR clinically isolated syndrome
• Medication is prescribed by or in consultation with a neurologist
• Member will not use Rebif 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 Rebif

Approval duration

12 months