Enbrel (etanercept) — CareFirst (Caremark)

Initial criteria

• Age ≥ 2 years
• Member meets one of the following: (a) mild to moderate disease with inadequate response or intolerance/contraindication to methotrexate, leflunomide, or another conventional synthetic drug (e.g., sulfasalazine); OR (b) has enthesitis or predominantly axial disease; OR (c) has severe disease

Reauthorization criteria

• Chart notes or medical record documentation supporting positive clinical response

Approval duration

12 months