Cimzia (certolizumab) — United Healthcare

Psoriatic Arthritis

Initial criteria

Diagnosis of active psoriatic arthritis
AND one of the following:
- History of failure to a 3 month trial of methotrexate at maximally indicated dose, unless contraindicated or clinically significant adverse effects are experienced (document date and duration)
OR patient has been previously treated with a targeted immunomodulator FDA-approved for psoriatic arthritis (e.g., Enbrel, adalimumab, Simponi, Orencia, Stelara, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla) as documented by claims history or medical records
OR both of the following: patient is currently on Cimzia therapy (document date and duration) AND patient has not received a manufacturer supplied sample or CIMplicity program assistance to establish as a current user
AND patient is not receiving Cimzia in combination with another targeted immunomodulator [e.g., Enbrel, adalimumab, Simponi, Orencia, Stelara, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla]
AND prescribed by or in consultation with a rheumatologist or dermatologist

Documentation of positive clinical response to Cimzia therapy
AND patient is not receiving Cimzia in combination with another targeted immunomodulator [e.g., Enbrel, adalimumab, Simponi, Orencia, Stelara, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla]

12 months