Tremfya — Medical Mutual

Initial criteria

• Patient age ≥ 18 years AND
• Patient meets ONE of the following: tried or currently taking corticosteroids, or contraindication; OR tried one other conventional systemic therapy for Crohn’s disease; OR has enterocutaneous or rectovaginal fistulas; OR had ileocolonic resection
• 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: objective beneficial clinical response compared with baseline OR improvement compared with baseline in at least one symptom (e.g., decreased pain, fatigue, stool frequency, blood in stool)

Approval duration

initial 6 months; reauth 1 year