Cosentyx (secukinumab) — CareFirst (Caremark)

Initial criteria

• Member age ≥ 4 years
• Authorization may be granted if member has previously received a biologic for active ERA
• OR all of the following are met:
• Active disease with ≥ 3 active joints and ≥ 1 site of active enthesitis (current or historical)
• Inadequate response to NSAIDs, sulfasalazine, or methotrexate OR intolerance/contraindication to NSAIDs, sulfasalazine, and methotrexate
• 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

• Member age ≥ 4 years
• Member achieves or maintains positive clinical response with improvement in one or more of: flares, number of joints with active arthritis, joints with limited movement, dactylitis, or enthesitis
• Member continues to meet TB and concomitant therapy requirements

Approval duration

12 months