Subsequent Courses - relapsing forms of multiple sclerosisįor members with a diagnosis of a relapsing form of MS (including relapsing-remitting and secondary progressive disease for those who continue to experience relapse) who have completed at least one previous course of therapy and treatment will start at least 12 months after the last dose of the prior treatment course. ![]() This medication must be prescribed by or in consultation with a neurologist.Īetna considers alemtuzumab (Lemtrada) medically necessary when criteria are met:įirst Course - relapsing forms of multiple sclerosisįor members with a diagnosis of a relapsing form of multiple sclerosis (MS) (including relapsing-remitting and secondary progressive disease for those who continue to experience relapse) who have had an inadequate response to two or more drugs indicated for MS or For information on site of service, see Utilization Management Policy on Site of Care for Specialty Drug Infusions. Note: For commercial plans, Site of Care Utilization Management Policy applies for alemtuzumab (Lemtrada), natalizumab (Tysabri), ocrelizumab (Ocrevus), immune globulin, and ublituximab-xiiy (Briumvi). For precertification of multiple sclerosis medications, call (866) 752-7021, or fax (888) 267-3277. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.įor Medicare Part B plans, call (866) 503-0857, or fax (844) 268-7263. Precertification of multiple sclerosis medications are required of all Aetna participating providers and members in applicable plan designs. the member has worsening disability (sustained worsening of Expanded Disability Status Scale score or neurological examination findings).the member has lesion progression by MRI (increased number or volume of gadolinium-enhancing lesions, T2 hyperintense lesions or T1 hypointense lesions) or.the member has increasing relapses, defined as two or more relapses in a year, or one severe relapse associated with either poor recovery or MRI lesion progression or. ![]() Footnote2** Failure of an adequate trial of therapy for multiple sclerosis is defined as follows:
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |