etanercept products — Cigna

Initial criteria

• Patient age > 18 years
• Patient has tried one corticosteroid
• Patient has tried one conventional synthetic DMARD for ≥ 2 months or was intolerant OR has tried one other systemic agent (e.g., Actemra, Arcalyst, Ilaris)
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for ≥ 6 months
• Patient experienced beneficial clinical response from baseline by at least one objective measure (e.g., resolution of fever, improvement in rash, normalization of CRP/ESR, reduced corticosteroid dose) OR experienced improvement in at least one symptom (e.g., less joint pain/tenderness, stiffness, or swelling; decreased fatigue; improved function or activities of daily living)

Approval duration

initial 6 months; reauth 1 year