etanercept products — Cigna

Initial criteria

• Patient age ≥ 4 years; AND patient has tried at least one traditional systemic agent for psoriasis for at least 3 months unless intolerant (e.g., methotrexate, cyclosporine, acitretin, or PUVA therapy); OR patient has a contraindication to methotrexate; AND the medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has been established on therapy for at least 3 months; AND patient experienced improvement in at least one of the following from baseline: estimated body surface area, erythema, induration/thickness, and/or scale; AND patient experienced improvement in symptoms such as decreased pain, itching, or burning

Approval duration

initial 3 months, reauth 1 year