Skyrizi Subcutaneous (on-body injector) — Cigna

Initial criteria

• Patient age ≥ 18 years
• According to the prescriber, the patient will receive three induction doses with Skyrizi intravenous within 3 months of initiating therapy with Skyrizi subcutaneous
• Medication 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 ≥ 1 of the following: (a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (examples include fecal markers, serum markers, endoscopic assessment, or reduced corticosteroid dose); OR (b) Compared with baseline, patient experienced an improvement in at least one symptom such as decreased pain, fatigue, stool frequency, or rectal bleeding

Approval duration

initial 6 months; renewal 1 year