Health Net
Ponvory (ponesimod)
Drugs for the Nervous System : Drugs for Multiple Sclerosis
  • Step Therapy Applies
  • Multiple Sclerosis (MS):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Patients Cardiac Medical History Required: No
    Concomitant use of other MS medication: No

    Secondary Progressive Multiple Sclerosis:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

  • Prior Authorization: Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

<< Return | Back to top