Zeposia — Medical Mutual
Ulcerative Colitis – Initial Therapy
Preferred products
- adalimumab-adaz
- adalimumab-adbm
- Cyltezo
- adalimumab-ryvk
- Simlandi
- Omvoh subcutaneous
- Skyrizi subcutaneous (on-body injector)
- Stelara subcutaneous
- Tremfya subcutaneous
- Velsipity
- Zymfentra
Initial criteria
- Patient meets the standard Multiple Sclerosis and Ulcerative Colitis – Zeposia Prior Authorization Policy criteria; AND
- Patient has tried TWO of the following: an adalimumab product, Omvoh subcutaneous, Skyrizi subcutaneous, ustekinumab subcutaneous product, Tremfya subcutaneous, Velsipity, or Zymfentra (trials of infliximab IV, Simponi SC, Entyvio IV or SC, Omvoh IV, Skyrizi IV, ustekinumab IV, or Tremfya IV also count)
Approval duration
6 months