Enbrel — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for treatment of graft versus host disease when either of the following criteria is met:
• Member has had an inadequate response to systemic corticosteroids.
• Member has an intolerance or contraindication to corticosteroids.

Reauthorization criteria

• Authorization of 12 months may be granted for all members (including new members) who are using the requested medication for chronic graft versus host 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