Velsipity (etrasimod) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of ulcerative colitis classified as moderately to severely active
• prescribed by or in consultation with a gastroenterologist
• experienced therapeutic failure or intolerance to at least two step 1 or 2a plan-preferred agents for the treatment of ulcerative colitis

Reauthorization criteria

• member has demonstrated disease stability or a beneficial response to therapy

Approval duration

12 months