ND Committee Review
Internal Medical Policy Committee 3-17-2021 Adopted policy was previously policy number I-171 (same title)
Internal Medical Policy Committee 3-23-2022 Update criteria wording, removed preferred brand agent step
Internal Medical Policy Committee 11-29-2022 - Effective December 01, 2022
- Added fingolimod as a preferred generic agent, and
- Removed hepatitis B criteria from the policy, 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
- 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