Purixan — CareFirst (Caremark)
Moderate to severe Crohn’s disease (CD)
Preferred products
- mercaptopurine
Initial criteria
- Member has a documented intolerable adverse event with the generic alternative mercaptopurine and the adverse event was not an expected adverse event attributed to the active ingredient as described in the prescribing information OR Member is unable to swallow the tablet formulation
Reauthorization criteria
- Member is using Purixan for moderately to severely active Crohn’s disease and achieves or maintains remission OR has a positive clinical response as evidenced by improvement in at least one of: abdominal pain or tenderness, diarrhea, body weight, abdominal mass, hematocrit, mucosal appearance on endoscopy/CTE/MRE/ultrasound, or improvement on a disease activity scoring tool (e.g., CDAI score)
Approval duration
12 months