adalimumab-adaz — CareFirst (Caremark)

Initial criteria

• Adult member
• Member has mild to moderate disease AND one of the following: inadequate response to methotrexate, leflunomide, or another conventional synthetic drug (e.g., sulfasalazine) administered at adequate dose and duration; intolerance or contraindication to methotrexate or leflunomide or another conventional synthetic drug (e.g., sulfasalazine); member has enthesitis or predominantly axial disease
• OR member has severe disease

Reauthorization criteria

• Adult member (including new members) using the medication for psoriatic arthritis shows positive clinical response evidenced by low disease activity or improvement in signs and symptoms with improvement in any of: number of swollen joints, number of tender joints, dactylitis, enthesitis, axial disease, skin/nail involvement, functional status, C-reactive protein (CRP)

Approval duration

12 months