Cosentyx (secukinumab) — CareFirst (Caremark)

Initial criteria

• Member age ≥ 2 years
• Authorization may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Otezla) indicated for PsA
• OR member meets one of the following:
• Mild to moderate disease AND inadequate response to methotrexate, leflunomide, or sulfasalazine OR intolerance/contraindication to those agents
• Enthesitis or predominantly axial disease
• Severe disease
• Negative TB test within 12 months of initiating therapy
• Not used concomitantly with another biologic or targeted synthetic drug for same indication

Reauthorization criteria

• Member age ≥ 2 years
• Member achieves or maintains positive clinical response evidenced by low disease activity or improvement in signs/symptoms when there is improvement in one or more of: swollen joints, tender joints, dactylitis, enthesitis, axial disease, skin/nail involvement, functional status, or C-reactive protein (CRP)
• Member continues to meet TB and concomitant therapy requirements

Approval duration

12 months