Zeposia (ozanimod) — Point32Health
Relapsing forms of multiple sclerosis including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults
Preferred products
- Humira
- Omvoh
- Rinvoq
- Simponi
- Skyrizi
- Xeljanz
- Yesintek
Initial criteria
- For multiple sclerosis: Documented diagnosis of relapsing multiple sclerosis
- For ulcerative colitis: Documented diagnosis of moderate to severe ulcerative colitis
- AND patient age ≥ 18 years
- AND prescribed by or in consultation with a gastroenterologist
- AND documentation of one (1) of the following: inadequate response or adverse reaction to a corticosteroid, a 5-aminosalycylate, 6-mercaptopurine, or methotrexate OR contraindication to corticosteroids, 5-aminosalycylates, 6-mercaptopurine, and methotrexate OR the patient is moderate to high risk as evidenced by deep ulcers on colonoscopy, long segments of small and/or large bowel involvement, perianal disease, extra-intestinal manifestations (e.g., fever, weight loss, abdominal pain, intermittent nausea/vomiting), history of bowel resections, or recent hospitalization for the disease OR previous treatment with a biologic agent indicated for the requested use OR the patient is new to the plan and has been stable on the requested agent prior to enrollment
- AND documentation of one (1) of the following: trial and failure with two (2) of the following Humira, Omvoh, Rinvoq, Simponi, Skyrizi, Xeljanz, or Yesintek OR contraindication to Humira, Omvoh, Rinvoq, Simponi, Skyrizi, Xeljanz, and Yesintek OR the patient is new to the plan and stable on Zeposia and the prescribing physician has documented that changing to a preferred product would result in adverse clinical outcomes