Tremfya — Medical Mutual

Initial criteria

• Patient age ≥ 18 years AND
• According to prescriber, patient will receive three induction doses with Tremfya intravenous within 3 months of initiating subcutaneous Tremfya AND
• Patient meets ONE: trial of one systemic agent for ulcerative colitis; OR (pouchitis AND tried antibiotic, probiotic, corticosteroid enema, or mesalamine enema)
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on Tremfya ≥ 6 months AND
• Patient meets at least ONE: objective beneficial clinical response compared with baseline (e.g., fecal markers, serum markers, endoscopic assessment, reduced corticosteroid dose) OR symptomatic improvement from baseline (e.g., decreased pain, fatigue, stool frequency, rectal bleeding)

Approval duration

initial 6 months; reauth 1 year