ND Committee Review
Internal Medical Policy Committee 3-17-2021
- Adopted
policy was previously policy number I-118 (same title)
Internal Medical Policy Committee 3-23-2022
- Updated
wording in criteria, no clinical content change
Internal Medical Policy Committee 9-28-2022 -
Effective October 01, 2022
- Added
Vumerity as a preferred brand agent
Internal Medical Policy Committee 11-29-2022 -
Effective December 01, 2022
- Added
fingolimod as a preferred generic agent,
and
- Removed
FDA labeled contraindications criteria from the policy;
and
- Added
Agents NOT to be used Concomitantly list,
and
- Updated
experimental/investigational statement
Internal Medical Policy Committee 3-23-2023
Effective April 03, 2023
- Added
teriflunomide as a preferred generic agent
- Removed
Aubagio and Gilenya from preferred brand agents
- Updated
Agents NOT to be used Concomitantly list and MS Disease Modifying Agents drug classes table
Internal Medical Policy Committee 9-12-2023
Effective October 01, 2023
- Added
Glatopa as a preferred generic agent
Internal Medical Policy Committee 7-16-2024
Effective October 01, 2024
- Updated
preferred agent criteria