Eticovo — Medical Mutual

Initial criteria

• Patient age > 18 years
• Patient has tried one conventional synthetic DMARD for at least 3 months OR has already had a 3-month trial of at least one biologic other than the requested drug
• Enbrel is prescribed by or in consultation with a rheumatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on etanercept therapy for at least 6 months
• Patient experienced a beneficial clinical response when assessed by at least one objective measure OR experienced improvement in at least one symptom (e.g., joint pain, stiffness, fatigue, function, swelling)
• Site of care medical necessity is met

Approval duration

initial 6 months, reauth 1 year