Enbrel — Medical Mutual

Initial criteria

• Patient age ≥ 2 years
• Patient has tried one systemic therapy for JIA (DMARD or NSAID) OR will be starting therapy concurrently with methotrexate, sulfasalazine, or leflunomide OR has contraindication to those OR has aggressive disease
• Medication prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on etanercept therapy for at least 6 months
• Patient experienced beneficial clinical response with objective measures OR experienced symptom improvement (e.g., motion limitation, pain, stiffness, function)
• Site of care medical necessity is met

Approval duration

initial 6 months, reauth 1 year