CurrentCignaPolicy N/A

Multiple Sclerosis (Oral -Fumarate) -Vumerity Prior Authorization Policy

Prior authorization policy for Vumerity (diroximel fumarate delayed-release capsules) for treatment of relapsing forms of multiple sclerosis under Cigna-administered benefit plans, including initial and continuation approval criteria, exclusions (non-covered uses), and requirement for specialist prescribing or consultation.

Policy Summary

PayerCigna

PolicyMultiple Sclerosis (Oral -Fumarate) -Vumerity Prior Authorization Policy

Policy CodePolicy N/A

Change TypeName and appendix updates (no criteria changes)

Effective DateJul 23, 2025

Next Review Date

Key ActionPrior authorization is required; approvals are provided for 1 year when criteria are met and the medication must be prescribed by or in consultation with a neurologist or MS specialist.

SourceLink

POLICY UPDATE CHANGES

Policy name changed to add 'Oral - Fumarate' and Appendix updates (removal/addition of agents) reflected in history.

1 yearApproval Duration (initial/continuation)

Relapsing formsCovered Indications

Concurrent DMTsNot Covered - Combination Use

Primary progressive MSNot Covered - Non-relapsing Forms