||All FDA approved indications not otherwise excluded from Part D. Plus patients already started on golimumab for a covered use.
||Concurrent use with another biologic therapy (eg. adalimumab, certolizumab pegol, etanercept, infliximab), or anakinra, rituximab, abatacept, or tocilizumab) or Xeljanz.
|Required Medical Information:
||Rheumatoid arthritis (RA), and UC adults.
||Adults with RA/Ankylosing spondylitis, prescribed by or in consultation with a rheumatologist. Psoriatic arthritis, prescribed by or in consultation with a rheumatologist or dermatologist. UC-prescribed by or in consultation with a gastroenterologist
||Authorization will be for12 months
||RA)/PsA/AS - approve if the patient has tried Enbrel AND Humira. Ulcerative colitits - approve if the patient has had a trial with Humira.
Last Modified on 11/18/2014