Kesimpta (ofatumumab) — Highmark
Relapsing forms of multiple sclerosis (MS): clinically isolated syndrome, relapsing-remitting disease, active secondary progressive disease
Initial criteria
- age ≥ 18 years
- Diagnosis of multiple sclerosis (ICD-10: G35) classified as one of the following relapsing forms: clinically isolated syndrome OR relapsing-remitting disease OR active secondary progressive disease
Reauthorization criteria
- Prescriber attests that the member has experienced a therapeutic response defined as one of the following: disease stability OR disease improvement OR delayed disease progression
Approval duration
24 months