Enbrel — Medical Mutual

Initial criteria

• Patient age ≥ 2 years
• Medication prescribed by or in consultation with a rheumatologist or dermatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient established on etanercept therapy ≥ 6 months
• Beneficial clinical response based on objective measures OR symptomatic improvement (e.g., joint pain, stiffness, fatigue, function)
• Site of care medical necessity is met

Approval duration

initial 6 months, reauth 1 year