Enbrel — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for members who have previously received Otezla or a biologic indicated for the treatment of Behcet’s disease.
• Authorization of 12 months may be granted for the treatment of Behcet’s disease when the member has had an inadequate response to at least one non-biologic medication for Behcet’s disease (e.g., azathioprine, colchicine, cyclosporine, systemic corticosteroids).

Reauthorization criteria

• Authorization of 12 months may be granted for all members (including new members) who are using the requested medication for Behcet’s disease and who achieve or maintain a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition.

Approval duration

12 months