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DrugTecfidera [dimethyl fumarate]

October 2013

Therapeutic Area - Multiple Sclerosis

Approval criteria

  • Tecfidera is being used as monotherapy for relapsing forms of multiple sclerosis AND
  • After documented compliance of at least 6 months of therapy, unless contraindicated, has had an inadequate response to Copaxone

Inadequate response is defined as meeting two of the following three criteria during treatment with another disease modifying drug:

  • Unchanged or increased relapse rate or ongoing severe relapses compared with the previous year despite treatment
  • The patient continues to have CNS lesion progression as measured by MRI
  • The patient continues to have worsening disability. Examples of worsening disability include, but are not limited to, decreased mobility or decreased ability to perform activities of daily living due to disease progression.

Quantity limit

  • 120 mg = 14
  • 240 mg = 60


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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