Adalimumab Products — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Patient has tried one conventional synthetic DMARD for at least 3 months (examples: methotrexate, leflunomide, hydroxychloroquine, sulfasalazine); exception allowed if patient has already had a 3-month trial with at least one biologic other than the requested medication
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response assessed by at least one objective measure OR patient experienced improvement in at least one symptom (decreased joint pain, morning stiffness, fatigue, improved function, or decreased swelling)

Approval duration

initial 6 months, reauth 1 year