etanercept products — Cigna

Initial criteria

• Patient age > 18 years
• Patient has tried one systemic corticosteroid OR has tried one other immunosuppressant for ≥ 2 months or was intolerant (examples: mycophenolate mofetil, cyclosporine)
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has been established on therapy for ≥ 4 months
• Patient experienced a beneficial clinical response, defined as improvement from baseline in at least one of the following: size, depth, and/or number of lesions
• Patient experienced improvement in at least one symptom, such as decreased pain and/or tenderness of affected lesions

Approval duration

initial 4 months; reauth 1 year