etanercept — Medica

Initial criteria

• age > 2 years
• patient has tried one other systemic medication for this condition OR will be starting therapy concurrently with methotrexate, sulfasalazine, or leflunomide OR has an absolute contraindication to methotrexate, sulfasalazine, or leflunomide OR has aggressive disease as determined by the prescriber
• prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• patient has been established on therapy for at least 6 months

Approval duration

initial: 6 months; reauth: 1 year