Omvoh (mirikizumab-mrkz) — United Healthcare

Initial criteria

• Diagnosis of moderately to severely active ulcerative colitis
• Patient is not receiving Omvoh in combination with another targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Entyvio (vedolizumab), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), ustekinumab, Tremfya (guselkumab), Xeljanz/Xeljanz XR (tofacitinib), Zeposia (ozanimod)]

Reauthorization criteria

• Documentation of positive clinical response to Omvoh therapy
• Patient is not receiving Omvoh in combination with another targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Entyvio (vedolizumab), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), ustekinumab, Tremfya (guselkumab), Xeljanz/Xeljanz XR (tofacitinib), Zeposia (ozanimod)]

Approval duration

12 months