Vumerity (diroximel fumarate) — 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 (clinically isolated syndrome, relapsing remitting disease, or 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 (clinically isolated syndrome, relapsing remitting disease, or active secondary progressive disease); AND
- Patient meets ONE of the following (a or b):
- a) Patient experienced a beneficial clinical response when assessed by at least one objective measure (e.g., stabilization or reduced worsening in MRI disease activity, EDSS score, NEDA-3/4, fatigue score, relapse rate, walking/gait measures, MS Functional Composite, brain volume loss); OR
- b) 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; 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