Cosentyx Intravenous — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• The medication is prescribed by or in consultation with a rheumatologist
• Patient has tried TWO of Enbrel, an adalimumab product, Rinvoq, Taltz, and Xeljanz/XR [documentation required]. A trial of multiple adalimumab products counts as ONE product. A trial of either or both Xeljanz products (Xeljanz and Xeljanz XR) collectively counts as ONE product. A trial of Cimzia, an infliximab product (e.g., Remicade, biosimilars), or Simponi (Aria or subcutaneous) also counts

Reauthorization criteria

• Patient has been established on Cosentyx intravenous or subcutaneous for at least 6 months
• Patient meets at least ONE of the following: a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline; OR b) Compared with baseline, patient experienced an improvement in at least one symptom, such as decreased pain or stiffness, or improvement in function or activities of daily living

Approval duration

initial 6 months; reauth 1 year