Hadlima — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for treatment of moderately to severely active Crohn’s disease

Reauthorization criteria

• Member using requested medication for moderately to severely active Crohn’s disease and achieves or maintains remission OR positive clinical response evidenced by low disease activity or improvement in signs and symptoms when there is improvement from baseline in: abdominal pain/tenderness, diarrhea, body weight, abdominal mass, hematocrit, appearance of mucosa on endoscopy/CTE/MRE/intestinal ultrasound, or disease activity score (e.g., CDAI)

Approval duration

12 months