Xeljanz — Cigna
Ankylosing Spondylitis – Initial Therapy
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Taltz
Initial criteria
- Patient meets the standard Inflammatory Conditions – Xeljanz/XR Prior Authorization Policy criteria; AND
- Patient has tried one of Enbrel or an adalimumab product; OR a trial of Cimzia, an infliximab product (e.g., Remicade, biosimilars), or Simponi (Aria or subcutaneous) also counts
Approval duration
6 months