Kesimpta — Medical Mutual

Relapsing forms of multiple sclerosis (clinically isolated syndrome, relapsing-remitting disease, active secondary progressive disease)

Initial criteria

Patient does NOT have a non-relapsing form of multiple sclerosis (e.g., primary progressive MS)
Patient will not use Kesimpta concurrently with other disease-modifying agents used for multiple sclerosis
Patient has a relapsing form of multiple sclerosis
Patient age ≥ 18 years
Patient has previously tried at least one generic disease modifying multiple sclerosis therapy OR patient has highly active/aggressive multiple sclerosis features (such as frequent and/or severe relapses, incomplete recovery from relapses, early accrual of impairment, heavy burden of MRI T2 lesions, multiple enhancing lesions at onset, high burden of gadolinium enhancing lesions, or early brain atrophy)
Medication is prescribed by or in consultation with a neurologist or a physician who specializes in the treatment of multiple sclerosis

Patient has a relapsing form of multiple sclerosis
Patient experienced a beneficial clinical response assessed by at least one objective measure (e.g., stabilization or reduced worsening in MRI lesions, EDSS scores, NEDA-3/NEDA-4, FSIQ-RMS, relapse reduction, MSFC score, six-minute walk test, brain volume loss) OR patient experienced stabilization, slowed progression, or improvement in at least one symptom (motor function, fatigue, vision, bowel/bladder function, spasticity, walking/gait, or pain/numbness/tingling)
Patient age ≥ 18 years
Medication is prescribed by or in consultation with a neurologist or a physician who specializes in the treatment of multiple sclerosis

1 year