adalimumab products — Medical Mutual

Initial criteria

• Must be prescribed by or in consultation with a relevant specialist (rheumatologist, dermatologist, gastroenterologist, ophthalmologist, pulmonologist, or neurologist depending on indication)
• Must meet relevant age requirements (≥2 years, ≥5 years, ≥6 years, ≥12 years, or ≥18 years depending on indication)
• Must meet indication-specific requirements (e.g., tried corticosteroids or DMARD, intolerance documented, evidence of disease severity, symptoms, or failure of other therapies)

Reauthorization criteria

• Patient has been established on therapy for a required minimum period (3 months, 4 months, or 6 months depending on indication)
• Patient achieved beneficial clinical response compared with baseline as measured by objective or symptomatic improvement appropriate to the condition

Approval duration

3-12 months depending on indication