Cimzia
| Covered Uses: | All FDA-approved indications not otherwise excluded from Part D |
| Exclusion Criteria: | Coverage is not provided for use of Enbrel in combination with other biologics e.g., Humira, Kineret, Remicade, etc. |
| Required Medical Information: | Coverage is provided in situations where the patient has been evaluated and screened for the presence of latent TB infection, where warranted, prior to initiating treatment with Cimzia. Coverage for Crohn's disease is provided in situations where the patient experienced intolerance/failure to Humira. Coverage for rheumatoid arthritis is provided in situations where the patient experienced intolerance/failure to Humira AND Enbrel |
| Age Restrictions: | Patient must be 18 years of age or older |
| Prescriber Restrictions: | |
| Coverage Duration: | Crohn's - 12 months, Rheumatoid arthritis - 5 years |
| Other Criteria: | Renewal coverage is provided in situations where treatment has provided clinical benefit. |
Last Modified on 12/19/2012