etanercept products — Medica

Initial criteria

• age > 18 years
• Patient has arthritis primarily in knees, ankles, elbows, wrists, hands, and/or feet AND has tried at least one conventional synthetic DMARD (examples: methotrexate, leflunomide, sulfasalazine) OR patient has axial spondyloarthritis AND has objective signs of inflammation defined as at least one of the following: C-reactive protein elevated beyond upper limit of normal OR sacroiliitis on MRI
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (examples: ASDAS, CRP, ESR) OR patient experienced an improvement in at least one symptom from baseline such as decreased pain or stiffness, or improvement in function or activities of daily living

Approval duration

initial 6 months, reauth 1 year