Cosentyx (secukinumab) — CareFirst (Caremark)

Initial criteria

• Adult member (age ≥ 18 years)
• Authorization may be granted if member has previously received a biologic indicated for HS
• OR one of the following:
• Inadequate response to oral antibiotics used for HS for ≥ 90 days (e.g., clindamycin, metronidazole, moxifloxacin, rifampin, tetracyclines)
• Intolerance or contraindication to oral antibiotics for HS
• 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 evidenced by low disease activity or improvement in signs/symptoms, meeting one or more of: reduction in abscess and inflammatory nodule count, reduced new sinus tracts/scarring, decreased inflammatory lesions, reduced pain, reduced suppuration, improved relapse frequency, improved quality of life, or improvement on a disease severity assessment tool
• Member continues to meet TB and concomitant therapy requirements

Approval duration

12 months