Erelzi — Medical Mutual

Initial criteria

• Patient age > 18 years
• Tried one corticosteroid
• Tried one DMARD for ≥ 2 months or was intolerant OR has trial of one biologic other than requested drug
• Medication prescribed by or in consultation with rheumatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient established on etanercept therapy for ≥ 6 months
• Beneficial clinical response by objective measures (resolution of fever, improved rash, improved markers, steroid sparing) OR symptomatic improvement (joint pain, stiffness, fatigue, function)
• Site of care medical necessity is met

Approval duration

initial 6 months, reauth 1 year