Cosentyx 300 mg — Blue Cross Blue Shield of Alabama

Initial criteria

• If Cosentyx 300 mg is requested as maintenance dosing, ONE of the following must apply:
• - Moderate to severe plaque psoriasis with or without coexistent active psoriatic arthritis AND requested dose 300 mg every 4 weeks
• - Hidradenitis suppurativa AND requested dose 300 mg every 4 weeks OR 300 mg every 2 weeks after inadequate response to 300 mg every 4 weeks for at least 3 months
• - Active psoriatic arthritis or active ankylosing spondylitis AND requested dose 300 mg every 4 weeks AND inadequate response to Cosentyx 150 mg every 4 weeks after at least 3 months

Reauthorization criteria

• Patient continues to have clinical benefit from Cosentyx therapy

Approval duration

12 months