Cosentyx (secukinumab) prefilled syringe — United Healthcare

Plaque Psoriasis

Initial criteria

Diagnosis of moderate to severe plaque psoriasis
One of the following: (a) All of the following: i. ≥3% body surface area involvement, palmoplantar, facial, genital involvement, or severe scalp psoriasis AND ii. History of failure to one topical therapy (corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, coal tar), unless contraindicated or adverse effects AND iii. History of failure to a 3-month trial of methotrexate at maximally indicated dose, unless contraindicated or adverse effects OR (b) Previously treated with a targeted immunomodulator FDA-approved for plaque psoriasis (e.g., Cimzia, adalimumab, Otezla, Skyrizi, Stelara, Tremfya, Enbrel) OR (c) Currently on Cosentyx therapy with documentation and has not received manufacturer supplied sample or assistance
Patient is not receiving Cosentyx in combination with another targeted immunomodulator [e.g., Enbrel, Cimzia, Simponi, Orencia, adalimumab, Stelara, Skyrizi, Tremfya, Taltz, Siliq, Ilumya, Xeljanz, Olumiant, Rinvoq, Otezla]
Prescribed by or in consultation with a dermatologist

Documentation of positive clinical response to Cosentyx therapy
Not receiving Cosentyx in combination with another targeted immunomodulator [Enbrel, Cimzia, Simponi, Orencia, adalimumab, Stelara, Skyrizi, Tremfya, Taltz, Siliq, Ilumya, Xeljanz, Olumiant, Rinvoq, Otezla]

12 months