Cosentyx (secukinumab) — CareFirst (Caremark)
active ankylosing spondylitis (AS)
Initial criteria
- Adult member (age ≥ 18 years)
- Authorization may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for AS or nr-axSpA
- OR member meets one of the following:
- Inadequate response to at least two NSAIDs
- Intolerance or contraindication to two or more NSAIDs
- Negative TB test within 12 months prior to therapy initiation
- Not used concomitantly with another biologic or targeted synthetic drug for same indication
Reauthorization criteria
- Adult member
- Member achieves or maintains positive clinical response with improvement in one or more of: functional status, total spinal pain, inflammation (morning stiffness), swollen joints, tender joints, or CRP
- Member continues to meet TB and concomitant therapy requirements
Approval duration
12 months