Cosentyx (secukinumab) — United Healthcare

Enthesitis-Related Arthritis

Initial criteria

Diagnosis of active enthesitis-related arthritis
AND One of the following:
- History of failure to two NSAIDs (e.g., ibuprofen, naproxen) at maximally indicated doses, each used for at least 4 weeks, unless contraindicated or clinically significant adverse effects are experienced (document drug, date, and duration of trials)
- OR Both of the following:
i. Patient is currently on Cosentyx therapy as documented by claims history or submission of medical records (document date and duration of therapy)
AND ii. Patient has not received a manufacturer supplied sample at no cost in prescriber office, or any form of assistance from the Novartis sponsored Cosentyx Connect (e.g., sample card which can be redeemed at a pharmacy for a free supply of medication) as a means to establish as a current user of Cosentyx
AND Patient is not receiving Cosentyx in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), adalimumab, Cimzia (certolizumab), Simponi (golimumab), Xeljanz (tofacitinib), Rinvoq (upadacitinib)]
AND Prescribed by or in consultation with a rheumatologist

Documentation of positive clinical response to Cosentyx therapy
AND Patient is not receiving Cosentyx in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), adalimumab, Cimzia (certolizumab), Simponi (golimumab), Xeljanz (tofacitinib), Rinvoq (upadacitinib)]

12 months