Dimethyl fumarate (Tecfidera®)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Relapsing forms of multiple sclerosis

This Medication is Not Approvable for the following condition(s):

  • Any condition not listed above as an approved indication

Dosing:

  • Starting dose: 120 mg twice a day x 7 days
  • Maintenance dose: 240mg twice a day

Approval:

Initial authorization is one year


 

Last review date: December 2, 2013

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