adalimumab-adaz — CareFirst (Caremark)

Initial criteria

• Adult member
• Has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for active ankylosing spondylitis or active non-radiographic axial spondyloarthritis
• OR inadequate response to at least two NSAIDs
• OR intolerance or contraindication to two or more NSAIDs

Reauthorization criteria

• Adult member (including new members) using the medication for ankylosing spondylitis or non-radiographic axial spondyloarthritis with positive clinical response evidenced by low disease activity or improvement in signs and symptoms with improvement in any of: functional status, total spinal pain, inflammation (morning stiffness), swollen joints, tender joints, C-reactive protein (CRP)

Approval duration

12 months