Pharmacotherapy of Multiple Sclerosis (drug-specific coverage criteria)
Defines medical necessity criteria, quantity limits, prescriber and age requirements, benefit management (medical vs pharmacy), documentation and coding for disease-modifying therapies for relapsing forms of multiple sclerosis for Premera Blue Cross plans; contains multiple drug-specific criteria and program/plan-specific variations.
2026 Update: Reviewed prescribing information for all drugs listed in policy. No changes to policy statements.
2025 Update: Added prescriber and age requirements for multiple products; moved several high-cost drugs to a different policy (5.01.644); updated Section structure and quantity limits.
2024 Updates: Multiple revisions including adding new products (Tascenso ODT, Tyruko, Briumvi), separate Metallic formulary criteria, and removal of certain prior trial requirements for many products in Metallic formulary.
Added generic cladribine to the policy with the same criteria as Mavenclad (cladribine).
06/01/26 formatting update removed references to Section 1/2/3 organization and removed non-formulary exception references.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.