Cosentyx (secukinumab) — United Healthcare

Hidradenitis Suppurativa

Initial criteria

Diagnosis of moderate to severe hidradenitis suppurativa (Hurley Stage II or III)
AND One of the following:
- History of failure to at least one oral antibiotic (e.g., doxycycline, clindamycin, rifampin) at maximally indicated doses, unless contraindicated or clinically significant adverse effects are experienced (document drug, date, and duration of trial)
- 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 the prescriber's office, or any form of assistance from a Novartis sponsored program (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., adalimumab, Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
AND Prescribed by or in consultation with a dermatologist

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

12 months