Ustekinumab subcutaneous injection — Cigna

Initial criteria

• Patient is age > 18 years; AND
• According to prescriber, patient will receive a single induction dose with ustekinumab intravenous within 2 months of initiating ustekinumab subcutaneous; AND
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on the requested drug for ≥ 6 months; AND
• Patient meets 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 decreased pain, fatigue, stool frequency, and/or decreased rectal bleeding

Approval duration

initial 6 months; reauth 1 year