Dimethyl fumarate (Tecfidera®)


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


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


Initial authorization is one year


Last review date: December 2, 2013

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