Teriflunomide (Aubagio)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

Aubagio is a non-preferred disease modifying agent for the treatment of relapsing forms of multiple sclerosis when all the criteria below are met

Patients must meet the following criteria for the indication(s) above:

  • 18 years or older, AND
  • Diagnosis of relapsing multiple sclerosis confirmed by a neurologist, AND
  • None of these drugs may be used in combination with each other or any other disease modifying therapy including natalizumab (Tysabri), mitoxantrone (Novantrone), alemtuzumab or fingolimod (Gilenya), AND
  • Patient is not taking in combination with leflunomide, AND
  • Patient does not have severe hepatic impairment, AND
  • For females of child baring age: patient is not pregnant

Dosing:

  • 7 mg or 14 mg orally once daily
  • Rosuvastatin: the dose of rosuvastatin should not exceed 10mg once daily in patients taking Aubagio

Approval:

  • Initial approval for one year
  • Renewal for one year if patient has clinical response