teriflunomide — 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
- 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
- Patient experienced a beneficial clinical response when assessed by at least one objective measure OR patient experienced stabilization, slowed progression, or improvement in at least one symptom (motor function, fatigue, vision, bowel/bladder function, spasticity, walking/gait, pain/numbness/tingling)
- 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