Siliq (brodalumab subcutaneous injection – Valeant) — Cigna

Initial criteria

• Patient age ≥ 18 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 (examples: methotrexate, cyclosporine, acitretin, or PUVA); OR b) Patient has contraindication to methotrexate as determined by prescriber; AND
• According to the prescriber, patient has been evaluated for risks of suicidal ideation or behavior versus benefits of therapy; AND
• According to the prescriber, patient does not have moderately severe to severe depression; AND
• Within past 5 years, patient does not have a history of suicidal ideation or suicidal behavior; AND
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has been established on therapy for ≥ 3 months; AND
• According to the prescriber, patient has been evaluated for risks of suicidal ideation or behavior versus benefits of therapy; AND
• According to the prescriber, patient does not have moderately severe to severe depression; AND
• According to the prescriber, patient does not have suicidal ideation or suicidal behavior; AND
• Patient experienced a beneficial clinical response defined as improvement from baseline in at least one of: 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 (decreased pain, itching, and/or burning)

Approval duration

initial 3 months; reauth 1 year