Velsipity — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient has had a trial of ONE systemic agent for ulcerative colitis; AND
• The 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 of the following: a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (prior to initiating the requested drug); OR b) Compared with baseline (prior to initiating Velsipity), patient experienced an improvement in at least one symptom, such as decreased pain, fatigue, stool frequency, and/or decreased rectal bleeding.

Approval duration

initial 6 months; reauth 1 year