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PonvoryMedica

Relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing remitting disease, and 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 experienced a beneficial clinical response when assessed by at least one objective measure (e.g., stabilization or reduced worsening in disease activity as evaluated by MRI, EDSS score, NEDA-3/NEDA-4, fatigue symptom and impact questionnaire-relapsing multiple sclerosis (FSIQ-RMS) scale, six-minute walk test, 12-Item MS Walking Scale, MSFC score, 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