Skyrizi — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years
• Patient meets ONE of the following conditions (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
• According to the prescriber, the patient will receive induction dosing with Skyrizi intravenous within 3 months of initiating therapy with Skyrizi subcutaneous
• The medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient meets at least one of the following: a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline; OR b) Compared with baseline, patient experienced an improvement in at least one symptom such as decreased pain, fatigue, stool frequency, and/or blood in stool

Approval duration

initial 6 months, reauth 1 year