Gilenya — Medica

multiple sclerosis

Preferred products

Patient meets the standard Multiple Sclerosis – Gilenya Prior Authorization Policy criteria
AND one of the following:
Patient has been established on Gilenya for ≥ 120 days
OR patient age ≥ 10 to < 18 years
OR prescriber states patient has highly active or aggressive multiple sclerosis meeting one of the following: rapidly advancing deterioration(s) in physical functioning, disabling relapse(s) with suboptimal response to systemic corticosteroids, MRI findings suggesting highly active/aggressive disease, or multiple sclerosis-related cognitive impairment (documentation required)
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

1 year