adalimumab products — Medica

Initial criteria

• age ≥ 18 years
• patient has tried ONE conventional synthetic DMARD (e.g., methotrexate, leflunomide, hydroxychloroquine, sulfasalazine) for at least 3 months OR has had a 3‑month trial with at least one biologic other than the requested medication; a biosimilar of the requested biologic does not count
• medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• patient has been established on adalimumab therapy for ≥ 6 months
• patient experienced a beneficial clinical response by at least one objective measure (e.g., CDAI, DAS28, PAS‑II, RAPID‑3, SDAI) OR an improvement in at least one symptom such as decreased joint pain, morning stiffness, or fatigue; improved function or activities of daily living; or decreased soft‑tissue swelling

Approval duration

initial 6 months, reauth 1 year