TASCENSO (fingolimod)

Self-Administration – oral

Diagnosis considered for coverage:
  • Relapsing forms of Multiple Sclerosis (MS): Indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in patients 10 years of age and older.

 

Coverage Criteria:

For diagnosis of MS: 

  • Patient has a diagnosis of a relapsing form of MS (e.g., clinically isolated syndrome, relapsing-remitting disease, secondary progressive disease, including active disease with new brain lesions), AND
  • Patient is 10 years of age or older, AND
  • Not used in combination with another disease-modifying therapy for MS AND 
  • Prescribed by or in consultation with a neurologist AND
  • One of the following: 
    • Failure after a trial of at least 4 weeks, contraindication, or intolerance to at least two of the following disease-modifying therapies for MS:
      • Avonex (interferon beta-1a) 
      • Betaseron (interferon beta-1b) 
      • Copaxone/Glatopa (glatiramer acetate) 
      • Dimethyl fumarate
      • Plegridy
      • Rebif 
      • Vumerity (diroximel fumarate), OR 
    • Both of the following:
      • Patient is younger than 18 years of age, AND 
      • Failure after a trial of at least 4 weeks or intolerance to Gilenya (fingolimod) 
    • For continuation of therapy, defined as no more than a 45-day gap 

 

Reauthorization Criteria:

For diagnosis of MS:

  • Patient demonstrates positive clinical response to therapy (e.g., stability in radiologic disease activity, clinical relapses, disease progression) AND
  • Not used in combination with another disease-modifying therapy for MS, AND
  • Prescribed by or in consultation with a neurologist
 
Dosing:

For diagnosis of MS:

  • Adults and pediatric patients 10 years of age and older weighing more than 40 kg:
    • 0.5 mg orally once-daily
  • Pediatric patients 10 years of age and older weighing less than or equal to 40 kg:
    • 0.25 mg orally once daily
  • Fingolimod doses higher than 0.5 mg are associated with a greater incidence of adverse reactions without additional benefit.

 

Coverage Duration: 
  • Initial: 12 months
  • Reauthorization: 12 months
Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information: 
  • According to the National MS Society, of the four disease courses that have been identified in MS, relapsing-remitting MS (RRMS) is characterized primarily by relapses, and secondary-progressive MS (SPMS) has both relapsing and progressive characteristics. These two constitute “relapsing forms of MS” if they describe a disease course that is characterized by the occurrence of relapses. The effectiveness of interferon beta in SPMS patients without relapses is uncertain.  
  • The advantage of using combination disease-modifying therapy (DMT) compared to monotherapy DMT use has not been demonstrated, but there are safety concerns, such as reduced efficacy or disease aggravation, with combination use. 
Policy Updates:
  • 08/15/2023 – New policy approved by P&T.
  • 6/1/2024 (policy effective date)- RRT MS update, removal of embedded DSE (P&T 5/20/2024) (P&T Meeting May) 
References:
  1. Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline: Disease-modifying therapies for adults with multiple sclerosis. Neurology 2018;90:777-788. 
  2. National Multiple Sclerosis Society. Types of MS. Available at: https://www.nationalmssociety.org/What-is-MS/Types-of-MS. Accessed March 29, 2019. 
  3. Wingerchuk, D., & Carter, J. (2014). Multiple Sclerosis: Current and Emerging Disease-Modifying Therapies and Treatment Strategies. Mayo Clinic Proceedings, 89(2), 225-240. 
  4. Sorensen, P., Lycke, J., Erälinna, J., Edland, A., Wu, X., & Frederiksen, J. et al. (2011). Simvastatin as add-on therapy to interferon beta-1a for relapsing-remitting multiple sclerosis (SIMCOMBIN study): a placebo-controlled randomized phase 4 trial. The Lancet Neurology, 10(8), 691-701. 
  5. Tascenso ODT Prescribing Information. Cycle Pharmaceuticals Ltd. Cambridge, United Kingdom. December 2022. 

Last review date: June 1, 2024

Rite Aid Pharmacy Patients: All Rite Aid pharmacies nationwide are closing! Please be on the lookout for information from Rite Aid pharmacies about their bankruptcy and store closures. Call your Rite Aid pharmacy for questions about your prescriptions and new pharmacy options. WHA is here to help as well. Contact Us via Phone