Taltz (ixekizumab) — United Healthcare
Ankylosing Spondylitis
Preferred products
- adalimumab (preferred products)
- Cimzia (certolizumab)
- Cosentyx (secukinumab)
- Enbrel (etanercept)
- Simponi (golimumab)
Initial criteria
- Diagnosis of active ankylosing spondylitis
- History of failure to two NSAIDs at maximally indicated doses, each used ≥4 weeks unless contraindicated or adverse effects (document drug/date/duration)
- OR previously treated with a targeted immunomodulator FDA-approved for ankylosing spondylitis (document drug/date/duration; e.g., adalimumab, Simponi, Rinvoq, Xeljanz, Enbrel)
- History of failure, contraindication, or intolerance to three preferred products: one preferred adalimumab product, Cimzia, Cosentyx, Enbrel, Simponi
- History of failure, contraindication, or intolerance to one of: Xeljanz/Xeljanz XR or Rinvoq
- Patient is not receiving Taltz in combination with another targeted immunomodulator [e.g., Enbrel, Cimzia, Cosentyx, Simponi, Orencia, adalimumab, Xeljanz, Olumiant, Rinvoq]
- Prescribed by or in consultation with a rheumatologist
Approval duration
12 months