Velsipity (etrasimod) — United Healthcare
moderately to severely active ulcerative colitis
Initial criteria
- Diagnosis of moderately to severely active ulcerative colitis
- AND Patient is not receiving Velsipity in combination with a targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Entyvio (vedolizumab), Olumiant (baricitinib), Omvoh (mirikizumab-mrkz), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Tremfya (guselkumab), ustekinumab, Xeljanz (tofacitinib)]
Reauthorization criteria
- Documentation of positive clinical response to Velsipity therapy
- AND Patient is not receiving Velsipity in combination with a targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Entyvio (vedolizumab), Olumiant (baricitinib), Omvoh (mirikizumab-mrkz), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Tremfya (guselkumab), ustekinumab, Xeljanz (tofacitinib)]
Approval duration
12 months