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The Policy VaultThe Policy Vault

Mayzent — Medical Mutual

multiple sclerosis

Preferred products

  • generic fingolimod capsules

Initial criteria

  • Patient meets the standard Multiple Sclerosis – Mayzent Prior Authorization Policy criteria
  • Patient has been established on Mayzent for ≥ 120 days OR Patient has tried generic fingolimod capsules AND has experienced inadequate efficacy or significant intolerance according to the prescriber
  • Note: Prior use of Gilenya with inadequate efficacy or significant intolerance (according to the prescriber) also counts

Approval duration

1 year