Cimzia — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has objective signs of inflammation defined as ONE of the following: a) C-reactive protein elevated beyond upper limit of normal; OR b) sacroiliitis on MRI
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on the requested drug for at least 6 months
• Patient meets ONE of the following: a) beneficial clinical response by objective measure (e.g., ASDAS, ASQoL, BASDAI, BASFI, BAS-G, BASMI, DFI, HAQ-S, or lab markers); OR b) improvement from baseline in at least one symptom such as decreased pain or stiffness or improved function

Approval duration

initial 6 months, renewal 1 year