Cosentyx intravenous — Medica

Plaque Psoriasis

Initial criteria

Patient meets the standard Inflammatory Conditions – Cosentyx Subcutaneous Prior Authorization Policy criteria; AND
Patient is currently receiving Cosentyx; AND
For Ankylosing Spondylitis: patient has tried TWO of Enbrel, an adalimumab product, Rinvoq, Taltz, or Xeljanz/XR [documentation required]; OR
For nr-axSpA: patient has tried TWO of Cimzia, Taltz, or Rinvoq [documentation required]; OR
For Plaque Psoriasis: patient has tried TWO of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, Stelara subcutaneous, Taltz, or Tremfya subcutaneous [documentation required]; OR
For Psoriatic Arthritis (age ≥ 18 years): patient has tried TWO of Enbrel, an adalimumab product, Otezla, Rinvoq/Rinvoq LQ, Skyrizi subcutaneous, Stelara subcutaneous, Taltz, Tremfya subcutaneous, or Xeljanz/XR [documentation required]

1 year