etanercept products — Cigna

Initial criteria

• Patient age > 18 years
• Patient meets ONE of the following: (a) has arthritis primarily in knees, ankles, elbows, wrists, hands and/or feet AND has tried ≥ 1 conventional synthetic DMARD (examples: methotrexate, leflunomide, sulfasalazine); OR (b) has axial spondyloarthritis AND has objective signs of inflammation defined as elevated CRP above upper limit of normal OR sacroiliitis reported on MRI
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for ≥ 6 months
• Patient experienced a beneficial clinical response from baseline by at least one objective measure (e.g., ASDAS, CRP, ESR) OR experienced improvement in at least one symptom (e.g., decreased pain, stiffness, or improved function/activities of daily living)

Approval duration

initial 6 months; reauth 1 year