tumor necrosis factor (TNF) inhibitor — Blue Cross Blue Shield of Kansas

Initial criteria

• Diagnosis of active PsA
• For treatment-naïve patients: first-line options include OSMs (methotrexate, sulfasalazine, cyclosporine, leflunomide, apremilast) OR TNF inhibitor, IL-17 inhibitor, or IL-12/23 inhibitor
• Use biologic as first-line option if severe PsA or severe psoriasis present
• If previously treated with oral small molecule and continued active disease, switch to a biologic is recommended over switching to a different OSM
• If previously treated with biologic and continued active disease, switch to another biologic OR consider adding methotrexate
• Assessment of efficacy should occur 3 months after initiation; change therapy if inadequate response