Enbrel — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for members who have previously received a biologic indicated for reactive arthritis.
• Authorization of 12 months may be granted for treatment of reactive arthritis when either of the following criteria is met:
• Member has had an inadequate response to methotrexate or sulfasalazine.
• Member has an intolerance or contraindication to methotrexate (see Appendix A) and sulfasalazine (e.g., porphyria, intestinal or urinary obstruction).

Reauthorization criteria

• Authorization of 12 months may be granted for all members (including new members) who are using the requested medication for reactive arthritis and who achieve or maintain a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition (e.g., tender joint count, swollen joint count, or pain).

Approval duration

12 months