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The Policy VaultThe Policy Vault

Zeposia — Medical Mutual

Multiple Sclerosis

Preferred products

  • fingolimod

Initial criteria

  • Patient meets the standard Multiple Sclerosis and Ulcerative Colitis – Zeposia Prior Authorization Policy criteria; AND
  • Patient meets ONE of the following: i. Patient has been established on Zeposia for ≥ 120 days; OR ii. Patient has tried generic fingolimod capsules AND experienced inadequate efficacy or significant intolerance according to the prescriber (prior use of Gilenya with inadequate efficacy or intolerance also counts)

Approval duration

1 year