Mavenclad (cladribine) — United Healthcare
Relapsing forms of multiple sclerosis (MS) including relapsing-remitting disease and active secondary progressive disease
Initial criteria
- Diagnosis of relapsing forms of multiple sclerosis (MS)
- AND
- Patient has not already received the FDA-recommended limit of 2 lifetime treatment courses (4 treatment cycles) of Mavenclad
Reauthorization criteria
- Documentation of positive clinical response to Mavenclad
- AND
- Patient has not already received the FDA-recommended limit of 2 lifetime treatment courses (4 treatment cycles) of Mavenclad
Approval duration
2 months (initial); 2 months (reauthorization, limited to 1 reauthorization allowing 2 cumulative treatment courses [4 treatment cycles])