Cosentyx — Blue Cross Blue Shield of Alabama

Initial criteria

• If Cosentyx 300 mg is requested as maintenance dosing, then ONE of the following:
• • Diagnosis of moderate to severe plaque psoriasis with or without coexistent active psoriatic arthritis AND requested dose is 300 mg every 4 weeks
• OR • Diagnosis of hidradenitis suppurativa AND ONE of the following: requested dose is 300 mg every 4 weeks OR requested dose is 300 mg every 2 weeks AND patient has tried and had an inadequate response to Cosentyx 300 mg every 4 weeks after at least a 3-month duration
• OR • Diagnosis of active psoriatic arthritis or active ankylosing spondylitis AND BOTH of the following: requested dose is 300 mg every 4 weeks AND patient has tried and had an inadequate response to Cosentyx 150 mg every 4 weeks after at least a 3-month duration

Approval duration

12 months