Cimzia — CareFirst (Caremark)

Initial criteria

• Adult member
• Previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Otezla) indicated for PsA OR any of the following:
• Mild to moderate disease AND (a) inadequate response to methotrexate, leflunomide, or sulfasalazine at adequate dose and duration, OR (b) intolerance or contraindication to those drugs
• OR member has enthesitis or predominantly axial disease
• OR member has severe disease

Reauthorization criteria

• Positive clinical response documented in chart notes or medical records.

Approval duration

12 months