Eticovo — Medical Mutual

Initial criteria

• Patient age ≥ 4 years
• Patient has tried at least one traditional systemic agent for ≥ 3 months OR psoralen plus UVA, unless intolerant, OR has contraindication to methotrexate OR has already tried a biologic for psoriasis
• Medication prescribed by or in consultation with a dermatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on etanercept therapy for at least 3 months
• Patient experienced beneficial clinical response defined as improvement from baseline in body surface area, erythema, induration, and/or scale
• Patient experienced improvement in at least one symptom such as decreased pain, itching, or burning

Approval duration

initial 3 months, reauth 1 year