Enbrel — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for members who have previously received a biologic indicated for the treatment of severe, refractory hidradenitis suppurativa.
• Authorization of 12 months may be granted for treatment of severe, refractory hidradenitis suppurativa when either of the following is met:
• Member has had an inadequate response to an oral antibiotic used for the treatment of hidradenitis suppurativa for at least 90 days (e.g., clindamycin, metronidazole, moxifloxacin, rifampin, tetracyclines).
• Member has an intolerance or contraindication to oral antibiotics used for the treatment of hidradenitis suppurativa.

Reauthorization criteria

• Authorization of 12 months may be granted for all members (including new members) who are using the requested medication for severe, refractory hidradenitis suppurativa and who achieve or maintain a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition when any of the following is met:
• Reduction in abscess and inflammatory nodule count from baseline
• Reduced formation of new sinus tracts and scarring
• Decrease in frequency of inflammatory lesions from baseline
• Reduction in pain from baseline
• Reduction in suppuration from baseline
• Improvement in frequency of relapses from baseline
• Improvement in quality of life from baseline
• Improvement on a disease severity assessment tool from baseline

Approval duration

12 months