Cimzia (certolizumab pegol subcutaneous injection [lyophilized powder or solution] – UCB) — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Patient has tried or is currently taking corticosteroids OR corticosteroids are contraindicated OR patient has tried one other conventional systemic therapy for Crohn’s disease (e.g., azathioprine, 6-mercaptopurine, methotrexate) OR patient has enterocutaneous (perianal or abdominal) or rectovaginal fistulas OR patient had ileocolonic resection to reduce risk of recurrence
• 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 (e.g., fecal lactoferrin, fecal calprotectin, C-reactive protein, MRE, CTE, endoscopic assessment, or reduced corticosteroid dose) OR patient experienced an improvement in at least one symptom compared with baseline (e.g., decreased pain, fatigue, stool frequency, blood in stool)

Approval duration

initial 6 months, reauth 1 year