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Plegridy — Medical Mutual

multiple sclerosis

Preferred products

  • generic glatiramer injection

Initial criteria

  • Patient meets the standard Multiple Sclerosis – Plegridy Prior Authorization Policy criteria
  • Patient has been established on Plegridy for ≥ 120 days OR Patient has tried generic glatiramer injection AND experienced inadequate efficacy or significant intolerance according to the prescriber
  • Note: Prior use of Copaxone or Glatopa also counts

Approval duration

1 year