etanercept products — Cigna

Initial criteria

• Patient will be starting on therapy concurrently with methotrexate, sulfasalazine, or leflunomide; OR patient has an absolute contraindication to methotrexate, sulfasalazine, or leflunomide; OR patient has aggressive disease as determined by the prescriber; AND the medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months; AND patient experienced either a beneficial clinical response measured objectively (e.g., Physician Global Assessment, Parent/Patient Global Assessment, Juvenile Arthritis Disease Activity Score, serum markers, corticosteroid reduction) OR an improvement in symptoms such as limitation of motion, joint pain or tenderness, morning stiffness, fatigue, or daily activities

Approval duration

initial 6 months, reauth 1 year