Cosentyx (secukinumab) - PA, NF
Indications for Prior Authorization
Cosentyx SC (secukinumab)
-
For diagnosis of Plaque Psoriasis (PsO)
Indicated for the treatment of moderate to severe plaque psoriasis in patients 6 years and older who are candidates for systemic therapy or phototherapy. -
For diagnosis of Psoriatic Arthritis (PsA)
Indicated for the treatment of active psoriatic arthritis in patients 2 years of age and older. -
For diagnosis of Ankylosing Spondylitis (AS)
Indicated for the treatment of adult patients with active ankylosing spondylitis. -
For diagnosis of Non-radiographic Axial Spondyloarthritis (nr-axSpA)
Indicated for the treatment of adult patients with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation. -
For diagnosis of Enthesitis-Related Arthritis (ERA)
Indicated for the treatment of active enthesitis-related arthritis in patients 4 years of age and older. -
For diagnosis of Hidradenitis Suppurativa (HS)
Indicated for the treatment of adult patients with moderate to severe hidradenitis suppurativa (HS).
Cosentyx IV (secukinumab)
-
For diagnosis of Psoriatic Arthritis (PsA)
Indicated for the treatment of adult patients with active psoriatic arthritis. -
For diagnosis of Ankylosing Spondylitis (AS)
Indicated for the treatment of adult patients with active ankylosing spondylitis. -
For diagnosis of Non-radiographic Axial Spondyloarthritis (nr-axSpA)
Indicated for the treatment of adult patients with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation.
Criteria
Cosentyx SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Plaque Psoriasis (PsO)
- Diagnosis of moderate to severe plaque psoriasis AND
- One of the following [2]:
- Greater than or equal to 3% body surface area involvement
- Severe scalp psoriasis
- Palmoplantar (i.e., palms, soles), facial, or genital involvement
- Patient is 6 years of age or older AND
- Prescribed by or in consultation with a dermatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of a 4-week trial and failure, contraindication, or intolerance to one of the following topical therapies [3]:
- corticosteroids (e.g., betamethasone, clobetasol)
- vitamin D analogs (e.g., calcitriol, calcipotriene)
- tazarotene
- calcineurin inhibitors (e.g., tacrolimus, pimecrolimus)
- Both of the following:
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following:
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- One formulary ustekinumab product*
- Skyrizi (risankizumab)
- Tremfya (guselkumab)
- Otezla (apremilast)
- Sotyktu (deucravacitinib)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by ONE of the following [2]:
- Reduction the body surface area (BSA) involvement from baseline
- Improvement in symptoms (e.g., pruritus, inflammation) from baseline
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to BOTH of the following:
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
Cosentyx SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Plaque Psoriasis (PsO)
- Patient demonstrates positive clinical response to therapy as evidenced by ONE of the following [1-3]:
- Reduction in the BSA involvement from baseline
- Improvement in symptoms (e.g., pruritus, inflammation) from baseline
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to BOTH of the following:
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
Cosentyx SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Plaque Psoriasis (PsO)
- Diagnosis of moderate to severe plaque psoriasis AND
- One of the following [2]:
- Greater than or equal to 3% body surface area involvement
- Severe scalp psoriasis
- Palmoplantar (i.e., palms, soles), facial, or genital involvement
- Patient is 6 years of age or older AND
- Prescribed by or in consultation with a dermatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of a 4-week trial and failure, contraindication, or intolerance to one of the following topical therapies [3]:
- corticosteroids (e.g., betamethasone, clobetasol)
- vitamin D analogs (e.g., calcitriol, calcipotriene)
- tazarotene
- calcineurin inhibitors (e.g., tacrolimus, pimecrolimus)
- Both of the following:
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following:
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- One formulary ustekinumab product*
- Skyrizi (risankizumab)
- Tremfya (guselkumab)
- Otezla (apremilast)
- Sotyktu (deucravacitinib)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by ONE of the following [1-3]:
- Reduction in the BSA involvement from baseline
- Improvement in symptoms (e.g., pruritus, inflammation) from baseline
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to BOTH of the following:
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
Cosentyx IV & SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Psoriatic Arthritis (PsA)
- Diagnosis of active psoriatic arthritis AND
- One of the following [4]:
- Actively inflamed joints
- Dactylitis
- Enthesitis
- Axial disease
- Active skin and/or nail involvement
- One of the following:
- Cosentyx SC: Patient is 2 years of age or older
- Cosentyx IV: Patient is 18 years of age or older
- Prescribed by or in consultation with one of the following:
- Dermatologist
- Rheumatologist
- One of the following:
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following:
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- Simponi (golimumab)
- One formulary ustekinumab product*
- Skyrizi (risankizumab-rzaa)
- Tremfya (guselkumab)
- Rinvoq/LQ (upadacitinib)
- Xeljanz/XR (tofacitinib/ER)
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to Taltz (ixekizumab) AND
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to ONE of the following:
- Bimzelx (bimekizumab-bkzx)
- Orencia (abatacept)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by at least one of the following [1, 4]:
- Reduction in the total active (swollen and tender) joint count from baseline
- Improvement in symptoms (e.g., pain, stiffness, pruritus, inflammation) from baseline
- Reduction in the body surface area (BSA) involvement from baseline
Cosentyx IV & SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Psoriatic Arthritis (PsA)
- Patient demonstrates positive clinical response to therapy as evidenced by at least one of the following [1, 4]:
- Reduction in the total active (swollen and tender) joint count from baseline
- Improvement in symptoms (e.g., pain, stiffness, pruritus, inflammation) from baseline
- Reduction in the BSA involvement from baseline
Cosentyx IV & SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Psoriatic Arthritis (PsA)
- Diagnosis of active psoriatic arthritis AND
- One of the following [4]:
- Actively inflamed joints
- Dactylitis
- Enthesitis
- Axial disease
- Active skin and/or nail involvement
- One of the following:
- Cosentyx SC: Patient is 2 years of age or older
- Cosentyx IV: Patient is 18 years of age or older
- Prescribed by or in consultation with one of the following:
- Dermatologist
- Rheumatologist
- One of the following:
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following:
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- Simponi (golimumab)
- One formulary ustekinumab product*
- Skyrizi (risankizumab-rzaa)
- Tremfya (guselkumab)
- Rinvoq/LQ (upadacitinib)
- Xeljanz/XR (tofacitinib/ER)
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to Taltz (ixekizumab) AND
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to ONE of the following:
- Bimzelx (bimekizumab-bkzx)
- Orencia (abatacept)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by at least one of the following [1, 4]:
- Reduction in the total active (swollen and tender) joint count from baseline
- Improvement in symptoms (e.g., pain, stiffness, pruritus, inflammation) from baseline
- Reduction in the BSA involvement from baseline
Cosentyx IV & SC
*Includes attestation that a total of two TNF inhibitors have already been tried in the past, and the patient should not be made to try a third TNF inhibitor. ** For review process only: Refer to the table in the Background section for carrier-specific formulary products
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Ankylosing Spondylitis (AS)
- Diagnosis of active ankylosing spondylitis AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen) at maximally tolerated doses [5] AND
- One of the following:
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following, or attestation demonstrating a trial may be inappropriate*
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- Simponi (golimumab)
- Rinvoq (upadacitinib)
- Xeljanz/XR (tofacitinib/ER)
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to BOTH of the following:
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx IV & SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Ankylosing Spondylitis (AS)
- Patient demonstrates positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx IV & SC
*Includes attestation that a total of two TNF inhibitors have already been tried in the past, and the patient should not be made to try a third TNF inhibitor. ** For review process only: Refer to the table in the Background section for carrier-specific formulary products
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Ankylosing Spondylitis (AS)
- Diagnosis of active ankylosing spondylitis AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different NSAIDs (e.g., ibuprofen, naproxen) at maximally tolerated doses [5] AND
- One of the following:
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to TWO of the following, or attestation demonstrating a trial may be inappropriate*
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- One formulary adalimumab product*
- Simponi (golimumab)
- Rinvoq (upadacitinib)
- Xeljanz/XR (tofacitinib/ER)
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to BOTH of the following:
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx IV & SC
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Non-radiographic Axial Spondyloarthritis (nr-axSpA)
- Diagnosis of active non-radiographic axial spondyloarthritis AND
- Patient has objective signs of inflammation (e.g., C-reactive protein [CRP] levels above the upper limit of normal and/or sacroiliitis on magnetic resonance imaging [MRI], indicative of inflammatory disease, but without definitive radiographic evidence of structural damage on sacroiliac joints.) [1, 3] AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different NSAIDs (e.g., ibuprofen, naproxen) at maximally tolerated doses [5] AND
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to ALL of the following:
- Cimzia (certolizumab pegol)
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
- Rinvoq (upadacitinib)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx IV & SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Non-radiographic Axial Spondyloarthritis (nr-axSpA)
- Patient demonstrates positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx IV & SC
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Non-radiographic Axial Spondyloarthritis (nr-axSpA)
- Diagnosis of active non-radiographic axial spondyloarthritis AND
- Patient has objective signs of inflammation (e.g., C-reactive protein [CRP] levels above the upper limit of normal and/or sacroiliitis on magnetic resonance imaging [MRI], indicative of inflammatory disease, but without definitive radiographic evidence of structural damage on sacroiliac joints.) [1, 3] AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different NSAIDs (e.g., ibuprofen, naproxen) at maximally tolerated doses [5] AND
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to ALL of the following:
- Cimzia (certolizumab pegol)
- Bimzelx (bimekizumab-bkzx)
- Taltz (ixekizumab)
- Rinvoq (upadacitinib)
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by improvement from baseline for at least one of the following [1, 5]:
- Disease activity (e.g., pain, fatigue, inflammation, stiffness)
- Lab values (erythrocyte sedimentation rate, C-reactive protein level)
- Function
- Axial status (e.g., lumbar spine motion, chest expansion)
- Total active (swollen and tender) joint count
Cosentyx SC
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Enthesitis-Related Arthritis (ERA)
- Diagnosis of active enthesitis-related arthritis AND
- Patient is 4 years of age or older AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different NSAIDs (e.g., ibuprofen, naproxen) at maximally tolerated doses [6]
Cosentyx SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Enthesitis-Related Arthritis (ERA)
- Patient demonstrates positive clinical response to therapy as evidenced by at least one of the following [1, 6]:
- Reduction in the total active (swollen and tender) joint count from baseline
- Improvement in symptoms (e.g., pain, stiffness, inflammation) from baseline
Cosentyx SC
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Enthesitis-Related Arthritis (ERA)
- Diagnosis of active enthesitis-related arthritis AND
- Patient is 4 years of age or older AND
- Prescribed by or in consultation with a rheumatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a minimum duration of one month trial and failure, contraindication, or intolerance to two different NSAIDs (e.g., ibuprofen, naproxen) at maximally tolerated doses [6]
Cosentyx SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Prior Authorization (Initial Authorization)
Length of Approval: 6 Month(s)
For diagnosis of Hidradenitis Suppurativa (HS)
- Diagnosis of moderate to severe hidradenitis suppurativa (i.e., Hurley Stage II or III) AND
- Prescribed by or in consultation with a dermatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a trial and failure, contraindication, or intolerance to one oral antibiotic (e.g., clindamycin, rifampin, tetracycline) [7] AND
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to one formulary adalimumab product* OR
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by at least one of the following [1, 7]:
- Reduction in the abscess and inflammatory nodule count from baseline
- Reduced formation of new sinus tracts and scarring
- Improvement in symptoms (e.g., pain, suppuration) from baseline
Cosentyx SC
Prior Authorization (Reauthorization)
Length of Approval: 12 Month(s)
For diagnosis of Hidradenitis Suppurativa (HS)
- Patient demonstrates positive clinical response to therapy as evidenced by at least one of the following [1, 7]:
- Reduction in the abscess and inflammatory nodule count from baseline
- Reduced formation of new sinus tracts and scarring
- Improvement in symptoms (e.g., pain, suppuration) from baseline
Cosentyx SC
* For review process only: Refer to the table in the Background section for carrier-specific formulary products
Non Formulary
Length of Approval: 6 Month(s)
For diagnosis of Hidradenitis Suppurativa (HS)
- Diagnosis of moderate to severe hidradenitis suppurativa (i.e., Hurley Stage II or III) AND
- Prescribed by or in consultation with a dermatologist AND
- Paid claims or submission of medical records (e.g., chart notes) confirming a trial and failure, contraindication, or intolerance to one oral antibiotic (e.g., clindamycin, rifampin, tetracycline) [7] AND
- One of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication, or intolerance to one formulary adalimumab product* OR
- Both of the following:
- Paid claims or submission of medical records (e.g., chart notes) confirming continuation of prior therapy, defined as no more than a 45-day gap in therapy AND
- Documentation of positive clinical response to therapy as evidenced by at least one of the following [1, 7]:
- Reduction in the abscess and inflammatory nodule count from baseline
- Reduced formation of new sinus tracts and scarring
- Improvement in symptoms (e.g., pain, suppuration) from baseline
P & T Revisions
2024-12-01, 2024-11-27, 2024-09-15, 2024-07-03, 2024-06-24, 2024-05-30, 2024-04-24, 2024-03-06, 2023-11-30, 2023-09-13, 2023-08-22, 2023-06-30, 2023-02-01, 2022-12-07, 2022-10-21, 2022-08-04, 2022-06-02, 2022-04-23, 2022-04-13, 2022-03-08, 2022-03-08, 2022-01-21, 2021-09-17, 2021-08-10, 2021-08-10, 2021-07-01, 2020-09-02, 2020-07-30, 2020-07-13, 2019-10-31
References
- Cosentyx prescribing information. Novartis Pharmaceuticals Corp. East Hanover, NJ. October 2023.
- Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019;80:1029-72.
- Elmets CA, Korman NJ, Farley Prater E, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2021;84:432-70.
- Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 2019;71(1):5-32.
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/spondyloarthritis research and treatment network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2019;71(10):1599-1613.
- Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res. 2019;71(6):717-734.
- Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101.
Revision History
- 2024-12-01: Added Bimzelx as a new step requirement to both initial and reauth criteria for PsO, and to initial criteria for PsA, AS, and nr-axSpA; Otezla and Sotyktu added as preferred alternatives for PsO; updated Stelara to "one formulary ustekinumab product"; removed manufacturers from "one formulary adalimumab product"; additional detail added to HS criteria, including a conventional step.
- 2024-11-27: Added Bimzelx as a new step requirement to both initial and reauth criteria for PsO, and to initial criteria for PsA, AS, and nr-axSpA; Otezla and Sotyktu added as preferred alternatives for PsO; updated Stelara to "one formulary ustekinumab product"; removed manufacturers from "one formulary adalimumab product"; additional detail added to HS criteria, including a conventional step.
- 2024-09-15: Removed anthralin and coal tar as topical step options for PsO
- 2024-07-03: Addition of Rinvoq LQ as an additional preferred alternative for PsA
- 2024-06-24: No criteria changes; updated background table to specify BI manufacturer for adalimumab-adbm
- 2024-05-30: Updated background table to include CalPERS formulary; no criteria changes
- 2024-04-24: Updated verbiage in the PsO, PsA, AS, and HS steps to say, "One formulary adalimumab product manufactured by AbbVie, Amgen, BI, or Sandoz"; added table to background section detailing preferred adalimumab products
- 2024-03-06: Updated verbiage in the PsO, PsA, AS, and HS steps to say, "One formulary adalimumab product manufactured by AbbVie, Amgen, BI, or Sandoz"; added table to background section detailing preferred adalimumab products
- 2023-11-30: Addition of Cosentyx IV to existing PsA, AS, and nr-axSpA criteria; addition of criteria for hidradenitis suppurativa (HS)
- 2023-09-13: Program update to standard reauthorization language. No changes to clinical intent.
- 2023-08-22: Annual review - no criteria changes; background updates
- 2023-06-30: Addition of Cyltezo, Hyrimoz, and brand Adalimumab-adaz as preferred step options for PsO, PsA, and AS
- 2023-02-01: Addition of Amjevita as another preferred step option for PsO, PsA, and AS; addition of Rinvoq as another step requirement for nr-axSpA
- 2022-12-07: Addition of Rinvoq as another step requirement for nr-axSpA
- 2022-10-21: Addition of Enbrel as an additional preferred step option for PsO, PsA, and AS. Further clinical detail and criteria added.
- 2022-08-04: Annual review - no criteria changes
- 2022-06-02: Added Rinvoq and Xeljanz/XR as additional preferred step options for AS
- 2022-04-23: 4/1/22: Updated the initial, and PsO reauth, PA criteria sections to include paid claims or submission of records requirements for the embedded steps and COT allowances. For NF criteria with continuation of therapy, added reauthorization criteria as part of COT requirement.
- 2022-04-13: 4/1/22: Updated the initial PA criteria sections to include paid claims or submission of records requirements for the embedded steps and COT allowances. For NF criteria with continuation of therapy, added reauthorization criteria as part of COT requirement.
- 2022-03-08: Updated the initial PA criteria sections to include paid claims or submission of records requirements for the embedded steps and COT allowances
- 2022-03-08: For NF criteria with continuation of therapy, added reauthorization criteria as part of COT requirement
- 2022-01-21: Removed continuation of therapy for the Taltz step in the psoriasis criteria.
- 2021-09-17: Update to Cosentyx NF criteria.
- 2021-08-10: Addition of the EHB formulary
- 2021-08-10: Updated psoriasis indication to include pediatric patients; addition of new strength for pediatric patients. Annual review.
- 2021-07-01: Addition of NF criteria
- 2020-09-02: Addition of Tremfya as a preferred step option for psoriatic arthritis; Addition of objective measures to the psoriasis reauthorization criteria; Formulary upudate to remove Simponi Aria as a preferred step option for PsA and AS
- 2020-07-30: Addition of new indication and criteria for Non-radiographic Axial Spondyloarthritis; background and reference updates
- 2020-07-13: Annual review - removed drug name from reauth criteria
- 2019-10-31: Examples of NSAIDs were added to the AS criteria.
HEALTHY LIVING