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Zeposia (ozanimod) — Medica

Multiple sclerosis (clinically isolated syndrome, relapsing remitting disease, and active secondary progressive disease)

Initial criteria

  • Patient meets the standard Multiple Sclerosis and Ulcerative Colitis (Oral – Sphingosine 1-Phosphate Receptor Modulator) – Zeposia Prior Authorization Policy criteria

Reauthorization criteria

  • Continuation of therapy approval may be provided if patient continues to meet the standard Zeposia Prior Authorization Policy criteria according to the referenced policy

Approval duration

1 year