Enbrel — Medical Mutual
Pyoderma Gangrenosum
Initial criteria
- Patient age > 18 years
- Patient has tried one systemic corticosteroid OR tried one immunosuppressant ≥ 2 months or was intolerant
- Prescription by or in consultation with dermatologist
Reauthorization criteria
- Patient established on therapy ≥ 4 months
- Beneficial clinical response (improvement in lesion size, depth, number)
- Symptom improvement (pain, tenderness of lesions)
Approval duration
initial 4 months, reauth 1 year