Ustekinumab subcutaneous injection — Cigna

Initial criteria

• Patient is age > 6 years; AND
• Medication is prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

• Patient has been established on the requested drug for ≥ 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; OR
• b) Compared with baseline, patient experienced improvement in at least one symptom, such as less joint pain, morning stiffness, or fatigue; improved function or activities of daily living; decreased soft tissue swelling in joints or tendon sheaths

Approval duration

initial 6 months; reauth 1 year