Humira
| Covered Uses: | All FDA approved indications not otherwise excluded from Part D. Additional off-label coverage is provided for moderate to severe ulcerative colitis |
| Exclusion Criteria: | Coverage is not provided for use of Humira in combination with other biologics e.g., Enbrel, Kineret or 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 Humira. |
| Age Restrictions: | |
| Prescriber Restrictions: | |
| Coverage Duration: | 12 months |
| Other Criteria: | Renewal coverage is provided in situations where treatment has provided clinical benefit. |
| Excluded Drug Criteria: |
Last Modified on 12/19/2012