Hadlima — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for treatment of moderately to severely active ulcerative colitis

Reauthorization criteria

• Member using requested medication for moderately to severely active ulcerative colitis 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: stool frequency, rectal bleeding, urgency of defecation, CRP, fecal calprotectin (FC), appearance of mucosa on endoscopy/CTE/MRE/ultrasound, or disease activity tool (e.g., UCEIS, Mayo score)

Approval duration

12 months