Adalimumab — United Healthcare

Initial criteria

• Diagnosis of active psoriatic arthritis
• History of failure to a 3 month trial of methotrexate at maximally indicated dose unless contraindicated or clinically significant adverse effects are experienced OR previously treated with targeted immunomodulator FDA-approved for psoriatic arthritis OR currently on adalimumab therapy and not received manufacturer supplied sample or manufacturer sponsored program assistance
• Patient is not receiving adalimumab in combination with another targeted immunomodulator (e.g., Enbrel, Cimzia, Simponi, Orencia, ustekinumab, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla)
• Prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

• Documentation of positive clinical response to adalimumab therapy
• Patient is not receiving adalimumab in combination with another targeted immunomodulator (e.g., Enbrel, Cimzia, Simponi, Orencia, ustekinumab, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla)

Approval duration

12 months