Imuldosa (ustekinumab-srlf subcutaneous injection - Accord) — Cigna

Initial criteria

• Patient is age ≥ 6 years; AND
• Patient meets ONE of the following (a or b):
• a) Patient has tried at least one traditional systemic agent for psoriasis for ≥ 3 months, unless intolerant; OR
• b) Patient has a contraindication to methotrexate as determined by the prescriber; AND
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has been established on the requested drug for ≥ 3 months; AND
• Patient experienced a beneficial clinical response defined as improvement from baseline in at least one of the following: estimated body surface area, erythema, induration/thickness, and/or scale of areas affected by psoriasis; AND
• Compared with baseline, patient experienced improvement in at least one symptom, such as decreased pain, itching, and/or burning

Approval duration

initial 3 months; reauth 1 year