Simponi (golimumab) — United Healthcare
Ankylosing Spondylitis
Initial criteria
- Diagnosis of active ankylosing spondylitis
- Patient is not receiving Simponi in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
Reauthorization criteria
- Documentation of positive clinical response to Simponi therapy
- Patient is not receiving Simponi in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
Approval duration
12 months