biologic immunomodulator agents — Blue Cross Blue Shield of Illinois

Initial criteria

• The patient has ONE of the following: tried and had an inadequate response to ONE conventional agent (6‑mercaptopurine, azathioprine, corticosteroids [e.g., prednisone, budesonide EC capsule], methotrexate) after at least a 3‑month duration of therapy OR has an intolerance or hypersensitivity to ONE conventional agent
• OR has an FDA‑labeled contraindication to ALL conventional agents used in CD OR has a medication history indicating use of another biologic immunomodulator agent that is FDA‑labeled or supported in compendia for CD

Approval duration

14 weeks