Betaseron — Medica
multiple sclerosis
Preferred products
- generic glatiramer injection
- generic dimethyl fumarate delayed-release capsules
Initial criteria
- Patient meets the standard Multiple Sclerosis – Betaseron/Extavia Prior Authorization Policy criteria
- AND one of the following:
- Patient has been established on Betaseron for ≥ 120 days
- OR patient has tried generic dimethyl fumarate delayed-release capsules (or Tecfidera) AND experienced inadequate efficacy or significant intolerance according to the prescriber
- OR patient has tried generic glatiramer injection (or Copaxone or Glatopa) AND experienced inadequate efficacy or significant intolerance according to the prescriber
Approval duration
1 year