Cimzia (certolizumab) — United Healthcare

Initial criteria

• (1) Diagnosis of active polyarticular juvenile idiopathic arthritis
• -AND- (2) Patient is not receiving Cimzia in combination with another targeted immunomodulator [e.g., adalimumab, Enbrel (etanercept), Simponi (golimumab), Orencia (abatacept), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
• -AND- (3) Prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• (1) Documentation of positive clinical response to Cimzia therapy
• -AND- (2) Patient is not receiving Cimzia in combination with another targeted immunomodulator [same list as above]

Approval duration

12 months