Cosentyx Intravenous — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Patient has objective signs of inflammation, defined as at least ONE of the following: a) C-reactive protein elevated beyond the upper limit of normal for the reporting laboratory; OR b) Sacroiliitis reported on magnetic resonance imaging
• The medication is prescribed by or in consultation with a rheumatologist
• Patient has tried TWO of Cimzia, Taltz, and Rinvoq [documentation required]. A trial of Enbrel, an adalimumab product, an infliximab product, or Simponi (Aria or subcutaneous) also counts. A trial of multiple adalimumab products counts as ONE product

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