etanercept — Medica

Initial criteria

• age > 2 years
• Patient has tried at least one conventional therapy (e.g., systemic corticosteroids, immunosuppressants such as azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, interferon alfa), unless previously tried a biologic other than the requested drug
• Medication is prescribed by or in consultation with a rheumatologist, dermatologist, ophthalmologist, gastroenterologist, or neurologist

Reauthorization criteria

• Patient has been established on therapy for at least 3 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline
• Compared with baseline, patient experienced an improvement in at least one symptom, such as decreased pain or improved visual acuity (if ophthalmic manifestations)

Approval duration

3 months initial, 1 year reauth