Mavenclad® (cladribine) - Step Therapy - UnitedHealthcare Commercial Plansopen_in_new
UnitedHealthcare commercial plan step therapy program requiring trial and failure (or contraindication/intolerance) of at least one listed disease-modifying therapy (DMT) prior to coverage of Mavenclad for relapsing forms of multiple sclerosis; includes exceptions for current users and lifetime treatment limits. Applies to new and continuing members per claims history and plan rules.
Program effective date set to 7/1/2025 and P&T approvals listed through 4/2025.
Revised criteria to clarify maximum recommended lifetime treatment (2 courses / 4 cycles).
Updated drug list to add Briumvi as an acceptable prior DMT option.
Clarified current user exception excludes those established via manufacturer samples or EMD Serono assistance.
Authorization duration updated to 2 months and limited to two authorizations to cover two cumulative treatment courses (4 cycles).
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.