Zeposia (ozanimod) — United Healthcare
moderately to severely active ulcerative colitis
Initial criteria
- Diagnosis of moderately to severely active ulcerative colitis
- AND
- Patient is not receiving Zeposia in combination with a targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Entyvio (vedolizumab), Omvoh (mirikizumab-mrkz), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Stelara (ustekinumab), Tremfya (guselkumab), Xeljanz (tofacitinib)]
Reauthorization criteria
- Documentation of positive clinical response to Zeposia therapy
- AND
- Patient is not receiving Zeposia in combination with a targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Entyvio (vedolizumab), Omvoh (mirikizumab-mrkz), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Stelara (ustekinumab), Tremfya (guselkumab), Xeljanz (tofacitinib)]
Approval duration
12 months