Adalimumab Products — Cigna

Initial criteria

• Patient is age > 2 years
• Patient has tried at least one conventional therapy (e.g., systemic corticosteroids or immunosuppressants) OR has ophthalmic manifestations of Behcet’s disease
• Medication is prescribed by or in consultation with a rheumatologist, dermatologist, ophthalmologist, gastroenterologist, or neurologist

Reauthorization criteria

• Patient has been established on therapy for at least 3 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline
• Compared with baseline, patient experienced improvement in at least one symptom such as decreased pain or improved visual acuity (if ophthalmic manifestations)

Approval duration

initial 3 months, reauth 1 year