UnitedHealthcare
Mayzent Starter Pack (siponimod)
Drugs for the Nervous System : Drugs for Multiple Sclerosis
  • Multiple Sclerosis (MS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    Patients Cardiac Medical History Required: No
    Concomitant use of other MS medication: No

    Secondary Progressive Multiple Sclerosis:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 60 month(s)

  • Prior Authorization: Multiple Sclerosis (MS):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Secondary Progressive Multiple Sclerosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 1 starter pack (12 tablets) per 365 days
<< Return | Back to top