Cimzia (certolizumab pegol) — Point32Health

Initial criteria

• Documented diagnosis of Crohn’s disease
• Patient is at least age ≥ 18 years
• Prescribed by or in consultation with a gastroenterologist
• Documentation of one (1) of the following: inadequate response or adverse reaction to at least two of the following: corticosteroids, 5-aminosalicyclates, 6-mercaptopurine, or methotrexate OR contraindication to corticosteroids, 5-aminosalicyclates, 6-mercaptopurine, and methotrexate OR patient is moderate to high risk—as evidenced by deep ulcers on colonoscopy, long segments of small and/or large bowel involvement, perianal disease, extra-intestinal manifestations, history of bowel resection, or recent hospitalization OR previous treatment with a biologic agent indicated for requested use OR patient is new to the plan and has been stable on the requested agent prior to enrollment