Ponvory (ponesimod)
Prior authorization policy governing pharmacy benefit coverage of Ponvory (ponesimod) for adult patients with relapsing forms of multiple sclerosis, including initial and continuation (≥1 year) approval criteria, documentation expectations, contraindicated/ not recommended uses, and prescriber requirements.
Annual Review Date and Last Revised Date shown as 05/22/2025 in header.
Coverage Summary
This prior authorization policy governs pharmacy benefit coverage of Ponvory (ponesimod) for adult patients with relapsing forms of multiple sclerosis. It includes separate recommended criteria for initial therapy (age ≥18, diagnosis of a relapsing form, and prescribed by or in consultation with a neurologist or MS specialist) and for continuation therapy after ≥1 year (documentation of a beneficial clinical response by at least one objective measure or stabilization/improvement in symptoms, and continued specialist prescribing). The policy specifies required documentation and that the Company may request records, test results, and provider credentials to support medical necessity; it also lists conditions not recommended for approval (including concurrent use with other disease-modifying MS agents and non‑relapsing MS) and provides standard initial and extended approval durations.
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