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The Policy VaultThe Policy Vault

Ponvory — Medical Mutual

multiple sclerosis

Preferred products

  • generic fingolimod capsules

Initial criteria

  • Patient meets the standard Multiple Sclerosis – Ponvory Prior Authorization Policy criteria
  • Patient has been established on Ponvory for ≥ 120 days OR
  • Patient has tried generic fingolimod capsules AND 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)
  • AND Patient has tried Mayzent or Zeposia AND experienced inadequate efficacy or significant intolerance according to the prescriber

Approval duration

1 year