Adalimumab Products — Cigna

Initial criteria

• Patient is age ≥ 5 years
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response from baseline when assessed by at least one objective measure OR patient experienced an improvement in at least one symptom (e.g., decreased pain, fatigue, stool frequency, and/or rectal bleeding)

Approval duration

initial 6 months, reauth 1 year