adalimumab products — Medica

Initial criteria

• age ≥ 2 years
• patient has tried ONE of the following: periocular, intraocular, or systemic corticosteroids; immunosuppressives; OR a biologic other than the requested medication; a biosimilar of the requested biologic does not count
• medication is prescribed by or in consultation with an ophthalmologist

Reauthorization criteria

• patient has been established on adalimumab therapy for ≥ 6 months
• patient experienced a beneficial clinical response by objective measure (e.g., best‑corrected visual acuity, assessment of chorioretinal/inflammatory retinal vascular lesions, anterior‑chamber cell grade, vitreous‑haze grade) OR improvement in symptoms such as decreased eye pain, redness, light sensitivity, blurred vision, or improved visual acuity

Approval duration

initial 6 months, reauth 1 year