Zeposia — Cigna
Ulcerative Colitis
Preferred products
- adalimumab-adaz
- adalimumab-adbm
- Cyltezo
- adalimumab-ryvk
- Simlandi
- Omvoh subcutaneous
- Skyrizi subcutaneous (on-body injector)
- Stelara subcutaneous
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Tremfya subcutaneous
- Velsipity
- Zymfentra
Initial criteria
- Patient must meet the standard Multiple Sclerosis and Ulcerative Colitis (Oral – Sphingosine 1-Phosphate Receptor Modulator) – Zeposia Prior Authorization Policy criteria
- If criterion 3Aii is not met, offer to review for a Preferred Product (adalimumab-adaz, adalimumab-adbm, Cyltezo, adalimumab-ryvk, Simlandi, Omvoh subcutaneous, Skyrizi subcutaneous (on-body injector), Stelara subcutaneous, Imuldosa subcutaneous, Selarsdi subcutaneous, ustekinumab-ttwe subcutaneous, Yesintek subcutaneous, Tremfya subcutaneous, Velsipity, or Zymfentra) using the respective standard Inflammatory Conditions Prior Authorization Policy criteria