Ultomiris — Medica

Initial criteria

• Patient is age ≥ 18 years
• Diagnosis was confirmed by a positive blood serum test for anti-aquaporin-4 antibody
• The medication is prescribed by or in consultation with a neurologist

Reauthorization criteria

• Patient is age ≥ 18 years
• Diagnosis was confirmed by a positive blood serum test for anti-aquaporin-4 antibody
• According to the prescriber, patient has had clinical benefit from Ultomiris (examples include reduction in relapse rate, reduction in symptoms such as pain, fatigue, motor function, or slowing progression of symptoms)
• The medication is prescribed by or in consultation with a neurologist

Approval duration

1 year