Omvoh (mirikizumab-mrkz subcutaneous injection – Eli Lilly) — Cigna

Initial criteria

• age ≥ 18 years
• According to the prescriber, the patient will receive three induction doses with Omvoh intravenous within 3 months of initiating therapy with Omvoh subcutaneous
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on the requested drug for at least 6 months
• Patient meets ONE of the following: a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline; OR b) Compared with baseline, patient experienced an improvement in at least one symptom such as decreased pain, fatigue, stool frequency, and/or decreased rectal bleeding

Approval duration

initial 6 months; reauth 1 year