Mayzent — Medical Mutual
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; AND
- Patient age ≥ 18 years; 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; AND
- Patient experienced a beneficial clinical response when assessed by at least one objective measure OR 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 sensation; 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