Hulio/adalimumab-fkjp — Cigna
Inflammatory Conditions – Adalimumab Products
Preferred products
- Cyltezo/adalimumab-adbm
- adalimumab-adaz
- Simlandi/adalimumab-ryvk
Initial criteria
- Patient meets the standard Inflammatory Conditions – Adalimumab Products Prior Authorization Policy criteria; AND
- Patient has tried ALL of Cyltezo/adalimumab-adbm, adalimumab-adaz, and Simlandi/adalimumab-ryvk [documentation required]; AND
- Patient cannot continue to use ALL Preferred medications (i.e., Cyltezo/adalimumab-adbm, adalimumab-adaz, and Simlandi/adalimumab-ryvk) due to formulation differences in the inactive ingredient(s) (e.g., differences in stabilizing agent, buffering agent, and/or surfactant) which, according to the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
per standard Inflammatory Conditions – Adalimumab Products Prior Authorization Policy