Subject: infliximab-Remicade and Biosimilars 2182-A SGM P2022
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REMICADE
(infliximab)
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AVSOLA
(infliximab-axxq)
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INFLECTRA
(infliximab-dyyb)
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RENFLEXIS
(infliximab-abda)
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infliximab
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Policy:
I. INDICATIONS
The indications below including FDA-approved indications
and compendial uses are considered a covered benefit
provided that all the approval criteria are met and the member
has no exclusions to the prescribed therapy.
A. FDA-Approved Indications
1. Adult patients with moderately to severely active Crohn’s
disease (CD) and fistulizing CD who have had an
inadequate response to conventional therapy
2. Pediatric patients 6 years of age and older with
moderately to severely active Crohn’s disease who have
had an inadequate response to conventional therapy
3. Moderately to severely active ulcerative colitis (UC) in
patients 6 years of age or older who have had an
inadequate response to conventional therapy
4. Adult patients with moderately to severely active
rheumatoid arthritis (RA), in combination with
methotrexate
5. Adult patients with active ankylosing spondylitis (AS)
6. Adult patients with active psoriatic arthritis (PsA)
7. Adult patients with chronic severe plaque psoriasis (PsO)
who are candidates for systemic therapy and when other
systemic therapies are medically less appropriate
B. Compendial Uses
1. Axial spondyloarthritis
2. Behcet’s disease
3. Hidradenitis suppurativa
4. Pyoderma gangrenosum
5. Sarcoidosis
6. Takayasu’s arteritis
7. Uveitis
8. Reactive arthritis
9. Immune checkpoint inhibitor toxicity
10. Acute graft versus host disease
11. Moderate to severe plaque psoriasis
All other indications are considered experimental/investigational
and not medically necessary.
II. DOCUMENTATION
Submission of the following information is necessary to initiate
the prior authorization review:
A. Crohn’s disease (CD)
1. Initial requests:
i. Chart notes, medical record documentation, or
claims history supporting previous medications
tried (if applicable), including response to therapy.
If therapy is not advisable, documentation of
clinical reason to avoid therapy.
ii. Chart notes or medical record documentation
supporting diagnosis of fistulizing Crohn’s disease
(if applicable).
2. Continuation requests: Chart notes or medical record
documentation supporting positive clinical response to
therapy or remission
B. Ulcerative colitis (UC)
1. Initial requests
i. Chart notes, medical record documentation, or
claims history supporting previous medications
tried (if applicable), including response to therapy.
If therapy is not advisable, documentation of
clinical reason to avoid therapy.
ii. Chart notes or medical record documentation of
hospitalization due to acute, severe ulcerative
colitis (if applicable).
2. Continuation requests: Chart notes or medical record
documentation supporting positive clinical response to
therapy or remission.
C. Rheumatoid arthritis (RA)
1. For initial requests:
i. Chart notes, medical record documentation, or
claims history supporting previous medications
tried (if applicable), including response to therapy.
If therapy is not advisable, documentation of
clinical reason to avoid therapy.
ii. Laboratory results, chart notes, or medical record
documentation of biomarker testing (i.e.,
rheumatoid factor [RF], anti-cyclic citrullinated
peptide [anti-CCP], and C-reactive protein [CRP]
and/or erythrocyte sedimentation rate [ESR]) (if
applicable).
2. For continuation requests: Chart notes or medical record
documentation supporting positive clinical response.
D. Ankylosing spondylitis (AS), axial spondyloarthritis (axSpA),
psoriatic arthritis (PsA), reactive arthritis, hidradenitis
suppurativa, and uveitis:
1. Initial requests: Chart notes, medical record
documentation, or claims history supporting previous
medications tried (if applicable), including response to
therapy. If therapy is not advisable, documentation of
clinical reason to avoid therapy.
2. Continuation requests: Chart notes or medical record
documentation supporting positive clinical response.
E. Plaque psoriasis (PsO)
1. Initial requests:
i. Chart notes or medical record documentation of
affected area(s) and body surface area (BSA)
affected (if applicable).
ii. Chart notes, medical record documentation, or
claims history supporting previous medications
tried (if applicable), including response to therapy.
If therapy is not advisable, documentation of
clinical reason to avoid therapy.
2. Continuation requests: Chart notes or medical record
documentation of decreased body surface area (BSA)
affected and/or improvement in signs and symptoms.
F. Behcet’s disease (initial requests only): Chart notes, medical
record documentation, or claims history supporting previous
medications tried, including response to therapy (if
applicable).
G. Pyoderma gangrenosum, sarcoidosis, Takayasu’s arteritis,
immune checkpoint inhibitor toxicity, and acute graft versus
host disease (initial requests only): Chart notes, medical
record documentation, or claims history supporting previous
medications tried (if applicable), including response to
therapy. If therapy is not advisable, documentation of clinical
reason to avoid therapy.
III. PRESCRIBER SPECIALTIES
This medication must be prescribed by or in consultation with
one of the following:
A. Crohn’s disease and ulcerative colitis: gastroenterologist
B. Rheumatoid arthritis, ankylosing spondylitis, axial
spondyloarthritis, Behcet’s disease, Takayasu’s arteritis, and
reactive arthritis: rheumatologist
C. Psoriatic arthritis and hidradenitis suppurativa:
rheumatologist or dermatologist
D. Plaque psoriasis and pyoderma gangrenosum:
dermatologist
E. Sarcoidosis: dermatologist or pulmonologist
F. Uveitis: ophthalmologist or rheumatologist
G. Immune checkpoint inhibitor toxicity and acute graft versus
host disease: oncologist or hematologist
IV. CRITERIA FOR INITIAL APPROVAL
A. Crohn’s disease (CD)
1. Authorization of 12 months may be granted for adult
members who have previously received a biologic
indicated for treatment of moderately to severely active
Crohn’s disease.
2. Authorization of 12 months may be granted for adult
members for treatment of moderately to severely active
CD when the member has had an inadequate response,
intolerance, or contraindication to at least one
conventional therapy option (see Appendix A).
3. Authorization of 12 months may be granted for
treatment of fistulizing CD in adult members.
4. Authorization of 12 months may be granted for
treatment of moderately to severely active CD when the
member is less than 18 years of age.
B. Ulcerative colitis (UC)
1. Authorization of 12 months may be granted for members
6 years of age and older who have previously received a
biologic or targeted synthetic drug (e.g., Xeljanz)
indicated for moderately to severely active ulcerative
colitis.
2. Authorization of 12 months may be granted for members
6 years of age and older for the treatment of moderately
to severely active UC when the member has had an
inadequate response, intolerance, or contraindication to
at least one conventional therapy option (see Appendix
B).
3. Authorization of 12 months may be granted for members
6 years of age and older who have been hospitalized for
acute severe UC (e.g., continuous bleeding, severe toxic
symptoms, including fever and anorexia).
C. Rheumatoid arthritis (RA)
1. Authorization of 12 months may be granted for adult
members who have previously received a biologic or
targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated
for moderately to severely active rheumatoid arthritis.
The requested medication must be prescribed in
combination with methotrexate or leflunomide unless
the member has a clinical reason not to use
methotrexate or leflunomide (see Appendix C).
2. Authorization of 12 months may be granted for adult
members for treatment of moderately to severely active
RA when all of the following criteria are met:
i. Member meets either of the following criteria:
a. Member has been tested for either of the
following biomarkers and the test was positive:
1. Rheumatoid factor (RF)
2. Anti-cyclic citrullinated peptide (anti-CCP)
b. Member has been tested for ALL of the
following biomarkers:
1. RF
2. Anti-CCP
3. C-reactive protein (CRP) and/or erythrocyte
sedimentation rate (ESR)
ii. Member is prescribed the requested
medication in combination with
methotrexate or leflunomide, or has a
clinical reason not to use
methotrexate or leflunomide (see
Appendix C).
iii. Member meets any of the following
criteria:
a. Member has experienced an
inadequate response to at least a
3-month trial of methotrexate
despite adequate dosing (i.e.,
titrated to at least 15 mg/week).
b. Member has an intolerance or
contraindication to methotrexate
(see Appendix C).
D. Ankylosing spondylitis (AS) and axial
spondyloarthritis (axSpA)
1. Authorization of 12 months may be granted for adult
members who have previously received a biologic or
targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated
for active ankylosing spondylitis or active axial
spondyloarthritis.
2. Authorization of 12 months may be granted for adult
members for treatment of active ankylosing spondylitis
or active axial spondyloarthritis when any of the
following criteria is met:
i. Member has experienced an inadequate response
to at least two non-steroidal anti-inflammatory
drugs (NSAIDs).
ii. Member has an intolerance or contraindication to
two or more NSAIDs.
E. Psoriatic arthritis (PsA)
1. Authorization of 12 months may be granted for adult
members who have previously received a biologic or
targeted synthetic drug (e.g., Rinvoq, Otezla) indicated
for active psoriatic arthritis.
2. Authorization of 12 months may be granted for adult
members for treatment of active psoriatic arthritis when
either of the following criteria is met:
i. Member has mild to moderate disease and meets
one of the following criteria:
a. Member has had an inadequate response to
methotrexate, leflunomide, or another
conventional synthetic drug (e.g., sulfasalazine)
administered at an adequate dose and duration.
b. Member has an intolerance or contraindication
to methotrexate or leflunomide (see Appendix
C), or another conventional synthetic drug
(e.g., sulfasalazine).
c. Member has enthesitis or predominantly axial
disease.
ii. Member has severe disease.
F. Plaque psoriasis (PsO)
1. Authorization of 12 months may be granted for adult
members who have previously received a biologic or
targeted synthetic drug (e.g., Sotyktu, Otezla) indicated
for the treatment of moderate to severe plaque
psoriasis.
2. Authorization of 12 months may be granted for adult
members for treatment of moderate to severe plaque
psoriasis in members when any of the following criteria
is met:
i. Crucial body areas (e.g., hands, feet, face, neck,
scalp, genitals/groin, intertriginous areas) are
affected.
ii. At least 10% of the body surface area (BSA) is
affected.
iii. At least 3% of body surface area (BSA) is affected
and the member meets any of the following
criteria:
a. Member has had an inadequate response or
intolerance to either phototherapy (e.g., UVB,
PUVA) or pharmacologic treatment with
methotrexate, cyclosporine, or acitretin.
b. Member has a clinical reason to avoid
pharmacologic treatment with methotrexate,
cyclosporine, and acitretin (see Appendix D).
G. Behcet’s disease
1. Authorization of 12 months may be granted for
members who have previously received Otezla or a
biologic indicated for the treatment of Behcet’s disease.
2. Authorization of 12 months may be granted for the
treatment of Behcet’s disease when the member has
had an inadequate response to at least one non-biologic
medication for Behcet’s disease (e.g., apremilast,
colchicine, systemic glucocorticoids, azathioprine).
H. Hidradenitis suppurativa
1. Authorization of 12 months may be granted for
members who have previously received a biologic
indicated for the treatment of severe, refractory
hidradenitis suppurativa.
2. Authorization of 12 months may be granted for
treatment of severe, refractory hidradenitis suppurativa
when either of the following is met:
i. Member has experienced an inadequate response
to an oral antibiotic for at least 90 days.
ii. Member has an intolerance or contraindication to
oral antibiotics.
I. Pyoderma gangrenosum
1. Authorization of 12 months may be granted for members
who have previously received a biologic indicated for
pyoderma gangrenosum.
2. Authorization of 12 months may be granted for
treatment of pyoderma gangrenosum when either of the
following is met:
i. Member has experienced an inadequate response
to corticosteroids or immunosuppressive therapy
(e.g., cyclosporine or mycophenolate mofetil).
ii. Member has an intolerance or contraindication to
corticosteroids and immunosuppressive therapy
(e.g. cyclosporine, mycophenolate mofetil).
J. Sarcoidosis
Authorization of 12 months may be granted for treatment of
sarcoidosis in members when any of the following criteria is
met:
1. Member has experienced an inadequate response to
corticosteroids or immunosuppressive therapy.
2. Member has an intolerance or contraindication to
corticosteroids and immunosuppressive therapy.
K. Takayasu’s arteritis
Authorization of 12 months may be granted for treatment
of refractory Takayasu’s arteritis when any of the follow
criteria is met:
1. Member has experienced an inadequate response to
corticosteroids or immunosuppressive therapy (e.g.,
methotrexate, azathioprine, or mycophenolate mofetil).
2. Member has an intolerance or contraindication to
corticosteroids and immunosuppressive therapy (e.g.,
methotrexate, azathioprine, or mycophenolate mofetil).
L. Uveitis
1. Authorization of 12 months may be granted for
members who have previous received a biologic
indicated for uveitis.
2. Authorization of 12 months may be granted for
treatment of uveitis when any of the following criteria is
met:
i. Member has experienced an inadequate response
to corticosteroids or immunosuppressive therapy
(e.g., methotrexate, azathioprine, or
mycophenolate mofetil).
ii. Member has an intolerance or contraindication to
corticosteroids and immunosuppressive therapy
(e.g., methotrexate, azathioprine, or
mycophenolate mofetil).
O. Reactive arthritis
1. Authorization of 12 months may be granted for
members who have previously received a biologic
indicated for reactive arthritis.
2. Authorization of 12 months may be granted for
treatment of reactive arthritis when any of the following
criteria is met:
i. Member has experienced an inadequate response
to at least a 3-month trial of one of the following
despite adequate dosing or maximally tolerated
dose:
a. Sulfasalazine (i.e., titrated to 1000 mg twice
daily)
b. Methotrexate (i.e., titrated to at least 15
mg/week)
ii. Member has an intolerance or contraindication to
methotrexate (see Appendix C) and sulfasalazine
(e.g., porphyria, intestinal or urinary obstruction).
P. Immune checkpoint inhibitor toxicity
1. Authorization of 1 month may be granted for treatment
of immune checkpoint inhibitor toxicity when either of
the following criteria is met:
i. Member has experienced an inadequate response,
intolerance, or contraindication to corticosteroids.
ii. Member has moderate or severe diarrhea or
colitis.
2. Authorization of 12 months may be granted for
treatment of immune checkpoint inhibitor toxicity when
the member has severe inflammatory arthritis and has
experienced an inadequate response, intolerance, or
contraindication to corticosteroids.
Q. Acute graft versus host disease
Authorization of 12 months may be granted for treatment
of acute graft versus host disease when either of the
following criteria is met:
1. Member has experienced an inadequate response to
systemic corticosteroids.
2. Member has an intolerance or contraindication to
corticosteroids.
V. CONTINUATION OF THERAPY
A. Crohn’s disease (CD)
1. Authorization of 12 months may be granted for all
members 6 years of age and older (including new
members) who are using the requested medication for
moderately to severely active or fistulizing Crohn’s
disease and who achieve or maintain remission.
2. Authorization of 12 months may be granted for all
members 6 years of age and older (including new
members) who are using the requested medication for
moderately to severely active or fistulizing Crohn’s
disease and who achieve or maintain a positive clinical
response as evidenced by low disease activity or
improvement in signs and symptoms of the condition
when there is improvement in any of the following from
baseline:
i. Abdominal pain or tenderness
ii. Diarrhea
iii. Body weight
iv. Abdominal mass
v. Hematocrit
vi. Endoscopic appearance of the mucosa
vii. Improvement on a disease activity scoring tool
(e.g., Crohn’s Disease Activity Index [CDAI] score)
B. Ulcerative colitis (UC)
1. Authorization of 12 months may be granted for all
members 6 years of age and older (including new
members) who are using the requested medication for
moderately to severely active ulcerative colitis and who
achieve or maintain remission.
2. Authorization of 12 months may be granted for all
members 6 years of age and older (including new
members) who are using the requested medication for
moderately to severely active ulcerative colitis and who
achieve or maintain a positive clinical response as
evidenced by low disease activity or improvement in
signs and symptoms of the condition when there is
improvement in any of the following from baseline:
i. Stool frequency
ii. Rectal bleeding
iii. Urgency of defecation
iv. C-reactive protein (CRP)
v. Fecal calprotectin (FC)
vi. Endoscopic appearance of the mucosa
vii. Improvement on a disease activity scoring tool
(e.g., Ulcerative Colitis Endoscopic Index of
Severity [UCEIS], Mayo score)
C. Rheumatoid arthritis (RA)
Authorization of 12 months may be granted for all adult
members (including new members) who are using the
requested medication for moderately to severely active
rheumatoid arthritis and who achieve or maintain a positive
clinical response as evidenced by disease activity
improvement of at least 20% from baseline in tender joint
count, swollen joint count, pain, or disability.
D. Ankylosing spondylitis (AS) and axial
spondyloarthritis (axSpA)
Authorization of 12 months may be granted for all adult
members (including new members) who are using the
requested medication for active ankylosing spondylitis or
active axial spondyloarthritis and who achieve or maintain a
positive clinical response with the requested medication as
evidenced by low disease activity or improvement in signs
and symptoms of the condition when there is improvement
in any of the following from baseline:
1. Functional status
2. Total spinal pain
3. Inflammation (e.g., morning stiffness)
E. Psoriatic arthritis (PsA)
Authorization of 12 months may be granted for all adult
members (including new members) who are using the
requested medication for psoriatic arthritis and who
achieve or maintain a positive clinical response as
evidenced by low disease activity or improvement in signs
and symptoms of the condition when there is improvement
in any of the following from baseline:
1. Number of swollen joints
2. Number of tender joints
3. Dactylitis
4. Enthesitis
5. Axial disease
6. Skin and/or nail involvement
F. Plaque psoriasis (PsO)
Authorization of 12 months may be granted for all adult
members (including new members) who are using the
requested medication for moderate to severe plaque
psoriasis and who achieve or maintain a positive clinical
response as evidenced by low disease activity or
improvement in signs and symptoms of the condition when
any of the following is met:
1. Reduction in body surface area (BSA) affected from
baseline
2. Improvement in signs and symptoms from baseline
(e.g., itching, redness, flaking, scaling, burning,
cracking, pain)
G. Hidradenitis suppurativa
Authorization of 12 months may be granted for all members
(including new members) who are using the requested
medication for severe, refractory hidradenitis suppurativa
and who achieve or maintain a positive clinical response as
evidenced by low disease activity or improvement in signs
and symptoms of the condition when any of the following is
met:
1. Reduction in abscess and inflammatory nodule count
from baseline
2. Reduced formation of new sinus tracts and scarring
3. Decrease in frequency of inflammatory lesions from
baseline
4. Reduction in pain from baseline
5. Reduction in suppuration from baseline
6. Improvement in frequency of relapses from baseline
7. Improvement in quality of life from baseline
8. Improvement on a disease severity assessment tool
from baseline
H. Uveitis
Authorization of 12 months may be granted for all members
(including new members) who are using the requested
medication for uveitis and who achieve or maintain a
positive clinical response as evidenced by low disease
activity or improvement in signs and symptoms of the
condition when the patient meets any of the following:
1. Reduced frequency of recurrence compared to baseline
2. Zero anterior chamber inflammation or reduction in
anterior chamber inflammation compared to baseline
3. Decreased reliance on topical corticosteroids
I. Reactive arthritis
Authorization of 12 months may be granted for all members
(including new members) who are using the requested
medication for reactive arthritis and who achieve or
maintain a positive clinical response as evidenced by low
disease activity or improvement in signs and symptoms of
the condition (e.g., tender joint count, swollen joint count,
or pain).
J. Immune checkpoint inhibitor toxicity and acute graft
versus host disease
All members (including new members) requesting
authorization for continuation of therapy must meet all
initial authorization criteria.
K. All other indications
Authorization of 12 months may be granted for all members
(including new members) who are using the requested
medication for an indication outlined in Section IV and who
achieve or maintain positive clinical response with the
requested medication as evidenced by low disease activity
or improvement in signs and symptoms of the condition.
VI. OTHER
For all indications: Member has had a documented negative
tuberculosis (TB) test (which can include a tuberculosis skin
test [PPD], an interferon-release assay [IGRA], or a chest x-
ray)* within 6 months of initiating therapy for persons who are
naïve to biologic drugs or targeted synthetic drugs associated
with an increased risk of TB.
* If the screening testing for TB is positive, there must be
further testing to confirm there is no active disease. Do not
administer the requested medication to members with active
TB infection. If there is latent disease, TB treatment must be
started before initiation of the requested medication.
For all indications: Member cannot use the requested
medication concomitantly with any other biologic drug or
targeted synthetic drug.
VII. DOSAGE AND ADMINISTRATION
Approvals may be subject to dosing limits in accordance with
FDA-approved labeling, accepted compendia, and/or evidence-
based practice guidelines.
VIII. APPENDICES
Appendix A: Examples of Conventional Therapy Options
for CD
1. Mild to moderate disease – induction of remission:
a. Oral budesonide
b. Alternatives: metronidazole, ciprofloxacin, rifaximin
2. Mild to moderate disease – maintenance of remission:
a. Azathioprine, mercaptopurine
b. Alternatives: oral budesonide, methotrexate
intramuscular (IM) or subcutaneous (SC), sulfasalazine
3. Moderate to severe disease – induction of remission:
a. Prednisone, methylprednisolone intravenously (IV)
b. Alternatives: methotrexate IM or SC
4. Moderate to severe disease – maintenance of remission:
a. Azathioprine, mercaptopurine
b. Alternative: methotrexate IM or SC
5. Perianal and fistulizing disease – induction of remission
a. Metronidazole ± ciprofloxacin, tacrolimus
6. Perianal and fistulizing disease – maintenance of remission
a. Azathioprine, mercaptopurine
b. Alternative: methotrexate IM or SC
Appendix B: Examples of Conventional Therapy Options
for UC
1. Mild to moderate disease – induction of remission:
a. Oral mesalamine (e.g., Apriso, Asacol, Asacol HD, Lialda,
Pentasa), balsalazide, olsalazine
b. Rectal mesalamine (e.g., Canasa, Rowasa)
c. Rectal hydrocortisone (e.g., Colocort, Cortifoam)
d. Alternatives: prednisone, azathioprine, mercaptopurine,
sulfasalazine
2. Mild to moderate disease – maintenance of remission:
a. Oral mesalamine, balsalazide, olsalazine, rectal
mesalamine
b. Alternatives: azathioprine, mercaptopurine,
sulfasalazine
3. Severe disease – induction of remission:
a. Prednisone, hydrocortisone IV, methylprednisolone IV
b. Alternatives: cyclosporine IV, tacrolimus, sulfasalazine
4. Severe disease – maintenance of remission:
a. Azathioprine, mercaptopurine
b. Alternative: sulfasalazine
Appendix C: Examples of Contraindications to
Methotrexate or Leflunomide
1. Clinical diagnosis of alcohol use disorder, alcoholic liver
disease or other chronic liver disease
2. Breastfeeding
3. Blood dyscrasias (e.g., thrombocytopenia, leukopenia,
significant anemia)
4. Elevated liver transaminases
5. History of intolerance or adverse event
6. Hypersensitivity
7. Interstitial pneumonitis or clinically significant pulmonary
fibrosis
8. Myelodysplasia
9. Pregnancy or currently planning pregnancy
10. Renal impairment
11. Significant drug interaction
Appendix D: Examples of Clinical Reasons to Avoid
Pharmacologic Treatment with Methotrexate,
Cyclosporine, or Acitretin
1. Clinical diagnosis of alcohol use disorder, alcoholic liver
disease or other chronic liver disease
2. Breastfeeding
3. Drug interaction
4. Cannot be used due to risk of treatment-related toxicity
5. Pregnancy or currently planning pregnancy
6. Significant comorbidity prohibits use of systemic agents (e.g., liver or kidney disease, blood dyscrasias, uncontrolled hypertension)
Place of Service:
Outpatient
The above policy is based on the following references:
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- Renflexis [package insert]. Jersey City, NJ. Organon LLC, Inc; January 2022.
- Infliximab [package insert]. Horsham, PA: Janssen Biotech, Inc.; October 2021.
- van der Heijde D, Ramiro S, Landewe R, et al. 2016 Update of the international ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;0:1-14.
- IBM Micromedex® DRUGDEX® System (electronic version). IBM Watson Health, Greenwood Village, Colorado, USA. Available at: https://www.micromedexsolutions.com/. Accessed August 10, 2022.
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- Lichtenstein GR, Loftus Jr EV, Isaacs KI, et al. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Am J Gastroenterol. 2018;113:481-517.
- Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762-784.
- Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79(6):685-699. doi:10.1136/annrheumdis-2019-216655.
- Singh JA,Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis 2016;68(1)1-26.
- Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 6: Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137-174.
- Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies; 2015 update. Ann Rheum Dis. 2016;75(3):499-510.
- Gladman DD, Antoni C, P Mease, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005;64(Suppl II):ii14–ii17.
- Coates LC, Soriano ER, Corp N, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol. 2022;18(8):465-479.
- Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011;70:896–904.
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Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
February 12, 2023
