teriflunomide — Medical Mutual

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 patient 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

365 days