Tremfya Subcutaneous — Cigna

Initial criteria

• Patient is age ≥ 18 years; AND
• According to the prescriber, the patient will receive three induction doses with Tremfya intravenous within 3 months of initiating therapy with Tremfya subcutaneous; AND
• The 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; AND
• Patient meets at least ONE of the following (a or b):
• a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (prior to initiating the requested drug); OR
• Note: Examples of assessment for inflammatory response include fecal markers (e.g., fecal calprotectin), serum markers (e.g., C-reactive protein), endoscopic assessment, and/or reduced dose of corticosteroids.
• b) Compared with baseline (prior to initiating the requested drug), 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