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Mavenclad (cladribine) — Point32Health

relapsing forms of multiple sclerosis including relapsing-remitting disease and active secondary progressive disease

Initial criteria

  • Documented diagnosis of relapsing multiple sclerosis
  • AND Documentation of one (1) of the following:
  • a. Trial and failure with one (1) of the following alternate disease-modifying multiple sclerosis agents: Aubagio, Plegridy, interferon beta-1a, interferon beta-1b, glatiramer acetate, an oral fumarate product, a sphingosine 1-phosphate receptor modulator product, a B-cell targeted product, Tysabri, or Lemtrada
  • OR b. Contraindication to ALL of the following disease-modifying multiple sclerosis agents: Interferon therapy, glatiramer acetate therapy, oral fumarates, sphingosine 1-phosphate receptor modulators, B-cell targeted therapies, and Aubagio
  • OR c. The patient is already being treated with Mavenclad