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The Policy VaultThe Policy Vault

MayzentMedical 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