etanercept products — Cigna

Initial criteria

• Patient age > 18 years; AND patient has tried at least one conventional synthetic DMARD for ≥ 3 months (e.g., methotrexate, leflunomide, hydroxychloroquine, sulfasalazine) unless already had a 3-month trial of at least one biologic other than the requested drug; 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 a beneficial clinical response measured objectively (e.g., CDAI, DAS28, PAS-II, RAPID-3, SDAI) OR improvement in symptoms such as decreased joint pain, morning stiffness, fatigue, function, or reduced swelling

Approval duration

initial 6 months, reauth 1 year