Simponi (golimumab subcutaneous injection) — Cigna

Initial criteria

• Patient is age ≥ 18 years
• The medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient meets at least ONE of the following: (a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (prior to initiating Simponi); OR (b) Compared with baseline (prior to initiating Simponi), 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