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The Policy VaultThe Policy Vault

Omvoh — Medical Mutual

Crohn’s Disease

Initial criteria

  • Patient age > 18 years; AND
  • According to the prescriber, patient will receive induction dosing with Omvoh intravenous within 3 months of initiating therapy with Omvoh subcutaneous; AND
  • Patient meets ONE of the following (a, b, c, or d): a) Patient has tried or is currently taking corticosteroids, or corticosteroids are contraindicated; OR b) Patient has tried one other conventional systemic therapy for Crohn’s disease; OR c) Patient has enterocutaneous (perianal or abdominal) or rectovaginal fistulas; OR d) Patient had ileocolonic resection; AND
  • Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

  • Patient has been established on therapy for at least 6 months; AND
  • Patient meets at least ONE of the following: a) Beneficial clinical response when assessed by at least one objective measure; OR b) Improvement in at least one symptom compared with baseline (such as decreased pain, fatigue, stool frequency, and/or blood in stool)

Approval duration

initial 6 months; reauth 1 year