Zeposia (ozanimod) — Medica
Ulcerative colitis
Preferred products
- Cyltezo (adalimumab-adbm)
- adalimumab-adaz
- Simlandi (adalimumab-ryvk)
- Omvoh SC
- Skyrizi SC (on-body injector)
- Stelara SC
- Imuldosa SC
- Selarsdi SC
- Ustekinumab-ttwe SC
- Yesintek SC
- Tremfya SC
- Velsipity
- Zymfentra
Initial criteria
- Patient meets the standard Multiple Sclerosis and Ulcerative Colitis (Oral – Sphingosine 1-Phosphate Receptor Modulator) – Zeposia Prior Authorization Policy criteria
- Patient has tried TWO of the following: an adalimumab product, Omvoh subcutaneous, Skyrizi subcutaneous, ustekinumab subcutaneous product, Tremfya subcutaneous, Velsipity, or Zymfentra
Reauthorization criteria
- Patient meets the standard Zeposia Prior Authorization Policy criteria
- Patient has tried TWO of an adalimumab product, Omvoh subcutaneous, Skyrizi subcutaneous, ustekinumab subcutaneous product, Tremfya subcutaneous, Velsipity, or Zymfentra; OR
- Patient has been established on Zeposia for at least 90 days AND prescription claims history indicates at least a 90-day supply was dispensed within the past 130 days [verification in prescription claims history required] OR prescriber verification that patient has been receiving Zeposia for at least 90 days via paid claims
Approval duration
6 months (initial), 1 year (reauthorization)