Omvoh — CareFirst (Caremark)

Initial criteria

• Prescribed by or in consultation with a gastroenterologist
• Member has moderately to severely active Crohn’s disease
• Member has had a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months prior to initiating therapy for persons naïve to biologic or targeted synthetic drugs associated with an increased risk of TB
• If TB screening is positive, there is further testing confirming no active disease (e.g., chest x-ray)
• Do not administer if active TB infection is present
• If latent TB infection is present, TB treatment must be started before initiation
• Medication will not be used concomitantly with any other biologic drug or targeted synthetic drug for the same indication

Reauthorization criteria

• Member continues treatment of moderately to severely active Crohn’s disease and has achieved or maintained remission OR a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms with improvement from baseline in any of the following: abdominal pain or tenderness, diarrhea, body weight, abdominal mass, hematocrit, appearance of the mucosa on endoscopy, computed tomography enterography (CTE), magnetic resonance enterography (MRE), or intestinal ultrasound, or improvement on a disease activity scoring tool (e.g., Crohn’s Disease Activity Index [CDAI] score)

Approval duration

12 months