Simponi (golimumab) subcutaneous injection — Medical Mutual

Initial criteria

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

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response when assessed by at least one objective measure OR patient experienced an improvement in at least one symptom (e.g., decreased joint pain, morning stiffness, fatigue, improved function, decreased swelling)

Approval duration

initial 6 months, reauth 1 year