Adalimumab Products — Cigna

Initial criteria

• Patient is age > 18 years
• Patient has tried at least one corticosteroid
• Patient has tried at least one immunosuppressive medication
• Medication is prescribed by or in consultation with a pulmonologist, ophthalmologist, or dermatologist

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 cough, fatigue, pain, palpitations, neurologic symptoms, or shortness of breath

Approval duration

initial 3 months, reauth 1 year