Cimzia — CareFirst (Caremark)
Ankylosing spondylitis
Initial criteria
- Adult member
- Previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for active AS or nr-axSpA OR any of the following:
- Inadequate response to at least two NSAIDs
- Intolerance or contraindication to two or more NSAIDs
Reauthorization criteria
- Positive clinical response documented in chart or medical records.
Approval duration
12 months