Ponvory — Medica

multiple sclerosis

Preferred products

Patient meets the standard Multiple Sclerosis – Ponvory Prior Authorization Policy criteria; AND
Patient meets ONE of the following (i or ii):
i. Patient has been established on Ponvory for ≥ 120 days; OR
ii. Patient meets BOTH of the following (a and b):
a) Patient meets BOTH of the following [(1) and (2)]: (1) Patient has tried generic dimethyl fumarate delayed-release capsules [documentation required]; AND (2) Patient has experienced inadequate efficacy or significant intolerance according to the prescriber [documentation required]. Note: Prior use of Tecfidera, Bafiertam, or Vumerity with inadequate efficacy or significant intolerance also counts.
b) Patient meets BOTH of the following [(1) and (2)]: (1) Patient has tried generic fingolimod capsules [documentation required]; AND (2) Patient has experienced inadequate efficacy or significant intolerance according to the prescriber [documentation required]. Note: Prior use of Gilenya (brand) or Tascenso ODT with inadequate efficacy or significant intolerance also counts.

1 year