adalimumab-bwwd — CareFirst (Caremark)

Initial criteria

• Member is using the requested medication for immunotherapy-related inflammatory arthritis
• Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms
• Member has a documented negative tuberculosis test within 12 months of initiating therapy (TST or IGRA) if naïve to biologic or targeted synthetic drugs
• If TB screening is positive, further testing has confirmed no active disease (e.g., chest x-ray) and active TB is excluded; latent TB must be treated prior to therapy
• Member is not using the requested medication concomitantly with any other biologic drug or targeted synthetic drug for the same indication

Reauthorization criteria

• Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms
• Ongoing compliance with TB testing and safety requirements
• No concomitant biologic or targeted synthetic use for same indication

Approval duration

12 months