| Anthem Blue Cross (HMO, PPO, EPO) |
| Vumerity (Starter) (diroximel fumarate) |
| Drugs for the Nervous System : Drugs for Multiple Sclerosis |
- Quantity Limit: 4 capsules per 1 day(s).
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(s)
- Available only through Specialty Pharmacy; Limited access;
- Multiple Sclerosis (MS):
Duration: 1 year(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: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Step Therapy: Secondary Progressive Multiple Sclerosis:
ST Multiple Generics
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