Simponi (golimumab) subcutaneous injection — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Simponi is prescribed by or in consultation with a rheumatologist or dermatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline OR compared with baseline patient experienced an improvement in at least one symptom (e.g., less joint pain, improved function, decreased swelling)
• Site of care medical necessity is met

Approval duration

initial 6 months, reauth 1 year