Zeposia (ozanimod) — United Healthcare

moderately to severely active ulcerative colitis (UC)

Preferred products

Diagnosis of moderately to severely active UC
AND One of the following: patient has had prior or concurrent inadequate response to a therapeutic course of oral corticosteroids and/or immunosuppressants (e.g., azathioprine, 6-mercaptopurine) OR patient has been previously treated with a biologic or targeted synthetic DMARD FDA-approved for the treatment of UC (e.g., adalimumab, Simponi (golimumab), ustekinumab, Xeljanz (tofacitinib), Rinvoq (upadacitinib)), documented by claims history or submission of medical records
AND One of the following: (a) history of failure, contraindication, or intolerance to two of the preferred products (document drug, date, duration of trial) OR (b) both of the following: patient is currently on Zeposia therapy as documented by claims history or medical records AND patient has not received a manufacturer supplied sample at no cost or any form of assistance from the Zeposia 360 Support Program as a means to establish as a current user of Zeposia
AND patient is not receiving Zeposia in combination with a targeted immunomodulator [e.g., adalimumab, Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib), ustekinumab, Skyrizi (risankizumab), Omvoh (mirikizumab-mrkz), Entyvio (vedolizumab)]
AND prescribed by or in consultation with a gastroenterologist

Documentation of positive clinical response to Zeposia therapy
AND patient is not receiving Zeposia in combination with another targeted immunomodulator [e.g., adalimumab, Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib), ustekinumab, Skyrizi (risankizumab), Omvoh (mirikizumab-mrkz), Entyvio (vedolizumab)]

12 months