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Kesimpta (ofatumumab subcutaneous injection – Novartis) — Cigna

Relapsing forms of multiple sclerosis including clinically isolated syndrome, relapsing remitting disease, and active secondary progressive multiple sclerosis in adults

Initial criteria

  • Patient age ≥ 18 years
  • Patient has a relapsing form of multiple sclerosis (examples include clinically isolated syndrome, relapsing remitting disease, and active secondary progressive disease)
  • Medication is prescribed by or in consultation with a neurologist or physician who specializes in treatment of multiple sclerosis

Reauthorization criteria

  • Patient has a relapsing form of multiple sclerosis
  • Patient experienced a beneficial clinical response when assessed by at least one objective measure OR patient experienced stabilization, slowed progression, or improvement in at least one symptom such as motor function, fatigue, vision, bowel/bladder function, spasticity, walking/gait, or pain/numbness/tingling sensation
  • Patient age ≥ 18 years
  • Medication is prescribed by or in consultation with a neurologist or physician who specializes in treatment of multiple sclerosis

Approval duration

1 year