Betaseron Extavia 1840 A Sgm P2024
Defines coverage and authorization criteria for Betaseron and Extavia for treatment of relapsing forms of multiple sclerosis (including clinically isolated syndrome and active secondary progressive disease) when prescribed by or in consultation with a neurologist. Specifies authorization duration and restrictions on concomitant use with other disease-modifying MS agents.
Indications limited to FDA-approved and compendial uses; all other indications considered experimental/investigational and not medically necessary.
Coverage Summary
Defines coverage and authorization criteria for Betaseron and Extavia for treatment of relapsing forms of multiple sclerosis (including clinically isolated syndrome, relapsing‑remitting disease, and active secondary progressive disease) in adults. Medication must be prescribed by or in consultation with a neurologist. Authorization of 12 months may be granted for initial therapy and for continuation when criteria are met. Use concomitantly with other disease‑modifying multiple sclerosis agents is not allowed; indications outside the FDA‑approved/compendial uses are considered experimental/investigational and not medically necessary.
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