Humira and biosimilars — CareFirst (Caremark)

Initial criteria

• Age ≥ 18 years
• Member previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for active ankylosing spondylitis or active non-radiographic axial spondyloarthritis OR member has had inadequate response to at least two NSAIDs OR intolerance/contraindication to two or more NSAIDs

Reauthorization criteria

• Positive clinical response with low disease activity or improvement in functional status, total spinal pain, inflammation (morning stiffness), swollen joints, tender joints, or CRP compared with baseline

Approval duration

12 months