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