adalimumab-adaz — CareFirst (Caremark)

Initial criteria

• Moderately to severely active ulcerative colitis

Reauthorization criteria

• Member (including new members) who achieves or maintains remission OR has positive clinical response evidenced by low disease activity or improvement in signs and symptoms with improvement in any of: stool frequency, rectal bleeding, urgency of defecation, C-reactive protein (CRP), fecal calprotectin (FC), mucosal appearance on endoscopy/CTE/MRE/ultrasound, improvement on scoring tool (e.g., UCEIS, Mayo score)

Approval duration

12 months