Tremfya 200 mg — Blue Cross Blue Shield of Alabama

Initial criteria

• If Tremfya 200 mg is requested, the patient must have a diagnosis of Crohn’s disease or ulcerative colitis
• If Omvoh 300 mg is requested as maintenance dosing, the patient must have a diagnosis of Crohn’s disease

Reauthorization criteria

• Patient continues to have clinical benefit from the requested agent

Approval duration

12 months