Enbrel
| Coves: | 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 Enbrel. |
| Age Restrictions: | |
| Prescriber Restrictions: | |
| Coverage Duration: | 12 months |
| Other Criteria: | Renewal coverage is provided in situations where treatment has provided clinical benefit. |
Last Modified on 12/19/2012