etanercept products — Cigna

Initial criteria

• Patient age > 2 years; AND patient has tried at least one conventional therapy (e.g., systemic corticosteroids, immunosuppressants such as azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, interferon alfa), unless already tried a biologic other than the requested drug; AND the medication is prescribed by or in consultation with a rheumatologist, dermatologist, ophthalmologist, gastroenterologist, or neurologist

Reauthorization criteria

• Patient has been established on therapy for at least 3 months; AND patient experienced a beneficial clinical response from baseline by at least one objective measure (e.g., best-corrected visual acuity, serum markers, ulcer or lesion size); AND patient experienced improvement in symptoms (e.g., decreased pain, improved visual acuity)

Approval duration

initial 3 months, reauth 1 year