| UnitedHealthcare |
| Zeposia 7-Day Starter Pack (ozanimod) |
| Drugs for the Nervous System : Drugs for Multiple Sclerosis |
- Quantity Limit: Maximum quantity 1 starter pack per year.
- Multiple Sclerosis (MS):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
Secondary Progressive Multiple Sclerosis:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
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