Cimzia — CareFirst (Caremark)
Immune checkpoint inhibitor-related toxicity (immunotherapy-related inflammatory arthritis)
Initial criteria
- Member has moderate or severe immunotherapy-related inflammatory arthritis
- Member has had an inadequate response to corticosteroids or a conventional synthetic drug (e.g., methotrexate, sulfasalazine, leflunomide, hydroxychloroquine) OR has an intolerance or contraindication to corticosteroids and a conventional synthetic drug (e.g., methotrexate, sulfasalazine, leflunomide, hydroxychloroquine)
Reauthorization criteria
- Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition
Approval duration
12 months