Tremfya (guselkumab) — CareFirst (Caremark)

moderately to severely active ulcerative colitis (UC)

Initial criteria

Member age ≥ 18 years
Medication prescribed by or in consultation with a gastroenterologist
Member has had a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months prior to initiating therapy; if positive, further testing confirms no active disease and latent TB is treated before starting Tremfya
Member will not use Tremfya concomitantly with any other biologic drug or targeted synthetic drug for the same indication
Authorization of 12 months may be granted for treatment of moderately to severely active ulcerative colitis

Authorization of 12 months may be granted for members using Tremfya for moderately to severely active ulcerative colitis who achieve or maintain remission OR a positive clinical response as evidenced by improvement from baseline in one or more of the following:
Stool frequency
Rectal bleeding
Urgency of defecation
C-reactive protein (CRP)
Fecal calprotectin (FC)
Appearance of mucosa on endoscopy, computed tomography enterography (CTE), magnetic resonance enterography (MRE), or intestinal ultrasound
Improvement on a disease activity scoring tool (e.g., Ulcerative Colitis Endoscopic Index of Severity [UCEIS], Mayo score)

12 months