Humira and biosimilars — CareFirst (Caremark)

Initial criteria

• Age ≥ 18 years
• Member has mild to moderate disease AND (inadequate response to methotrexate, leflunomide, or another conventional synthetic drug such as sulfasalazine administered at adequate dose and duration OR intolerance/contraindication to methotrexate, leflunomide, or another conventional synthetic drug)
• Member has enthesitis or predominantly axial disease OR member has severe disease

Reauthorization criteria

• Member continues to have positive clinical response evidenced by low disease activity or improvement in signs and symptoms compared with baseline (improvement in swollen joints, tender joints, dactylitis, enthesitis, axial disease, skin/nail involvement, functional status, or CRP)

Approval duration

12 months