Cosentyx (secukinumab) prefilled syringe — United Healthcare

Ankylosing Spondylitis

Initial criteria

Diagnosis of active ankylosing spondylitis
One of the following: (a) History of failure to two NSAIDs at maximally indicated doses, each ≥4 weeks, unless contraindicated or adverse effects OR (b) Previously treated with a targeted immunomodulator FDA-approved for ankylosing spondylitis (e.g., adalimumab, Simponi, Xeljanz/Xeljanz XR, Rinvoq, Enbrel) OR (c) Currently on Cosentyx therapy with documentation and has not received manufacturer supplied sample or assistance
Not receiving Cosentyx in combination with another targeted immunomodulator [Enbrel, Cimzia, Simponi, Orencia, adalimumab, Xeljanz, Olumiant, Rinvoq]
Prescribed by or in consultation with a rheumatologist

Documentation of positive clinical response to Cosentyx therapy
Not receiving Cosentyx in combination with another targeted immunomodulator [Enbrel, Cimzia, Simponi, Orencia, adalimumab, Xeljanz, Olumiant, Rinvoq]

12 months