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Mayzent (siponimod)Medica

Relapsing forms of multiple sclerosis (clinically isolated syndrome, relapsing remitting disease, active secondary progressive disease)

Initial criteria

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

Reauthorization criteria

  • Patient has a relapsing form of multiple sclerosis (examples include clinically isolated syndrome, relapsing remitting disease, and active secondary progressive disease); AND
  • Patient is currently receiving Mayzent for ≥ 1 year; AND
  • Patient experienced a beneficial clinical response when assessed by at least one objective measure (e.g., MRI showing absence or decrease in gadolinium enhancing lesions or new T2 lesions, stabilization or improvement on EDSS, NEDA-3/4, FSIQ-RMS, reduction or absence of relapses, improvement or maintenance on the six-minute walk test or 12-Item MS Walking Scale, improvement on MSFC score, or attenuation of brain volume loss); 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; AND
  • Medication is prescribed by or in consultation with a neurologist or a physician who specializes in the treatment of multiple sclerosis

Approval duration

1 year