Subject: Specialty Quantity Limit Cosentyx 1737-H P2025

Drug

COSENTYX  (secukinumab)

Policy:

Program Description

The standard limit is designed to allow a quantity sufficient for the most common uses of the medication. If the member’s plan allows a quantity limit exception review for the requested medication, coverage of an additional quantity may be provided up to the exception limit with prior authorization.

Covered Quantities

Coverage up to the exception limits may be provided with prior authorization via the Specialty Post Limit Quantity Exception Criteria for approval.

Medication	Standard Limit	Exception Limit
Cosentyx (secukinumab) 75 mg/0.5 mL   prefilled syringe	1 syringe per 28 days	5 syringes per 28 days
Cosentyx (secukinumab) 150 mg/mL   prefilled syringe/ Sensoready pen	1 syringe/pen per 28 days	5 syringes/pens per 28 days
Cosentyx (secukinumab) 300 mg/2 mL   prefilled syringe/ UnoReady pen	1 syringe/pen per 28 days	Loading dose:   •  5 pens/syringes per 28 days   Maintenance dose (HS inadequate response):   •  2 pens/syringes per 28 days
Cosentyx (secukinumab) 300 mg dose carton   containing (2) 150 mg/mL   prefilled syringes or (2) 150 mg/mL Sensoready pens	1 dose carton per 28 days	Loading dose:   •  5 dose cartons per 28 days   Maintenance dose (HS inadequate response):   •  2 dose cartons per 28 days
Cosentyx (secukinumab) 125 mg/5 mL   single-dose vial	15 mL (3 vials) per 28 days	Loading dose:   •  ≤ 100 kg: 25 mL (5 vials) per 28 days   •  > 100 kg: 50 mL (10 vials) per 28 days

FDA-recommended Dosing

Pre-filled pen or syringe

Psoriatic arthritis (PsA)/Ankylosing spondylitis (AS)/Non-radiographic axial spondyloarthritis (NR-axSpA), adults

Loading doses (optional)

150 mg at weeks 0, 1, 2, 3, and 4

Maintenance dose

150 mg every 4 weeks

Continued active PsA/AS

300 mg every 4 weeks

Psoriatic arthritis, pediatric (2 years and older)

≥ 15 kg to < 50 kg: 75 mg at weeks 0, 1, 2, 3, and 4, then 75 mg every 4 weeks

≥ 50 kg: 150 mg at weeks 0, 1, 2, 3, and 4, then 150 mg every 4 weeks

Plaque psoriasis, with or without coexistent psoriatic arthritis, adults

Loading doses

300 mg at weeks 0, 1, 2, 3, and 4

Maintenance dose

300 mg every 4 weeks (for some patients, a dose of 150 mg may be acceptable)

Plaque psoriasis, pediatric (6 years and older)

< 50 kg: 75 mg at weeks 0, 1, 2, 3, and 4, then 75 mg every 4 weeks

≥ 50 kg: 150 mg at weeks 0, 1, 2, 3, and 4, then 150 mg every 4 weeks

Enthesitis-Related Arthritis (4 years and older)

≥ 15 kg to < 50 kg: 75 mg at weeks 0, 1, 2, 3, and 4, then 75 mg every 4 weeks

≥ 50 kg: 150 mg at weeks 0, 1, 2, 3 and 4, then 150 mg every 4 weeks

Hidradenitis Suppurativa (HS)

Loading dose

300 mg at weeks 0, 1, 2, 3, and 4

Maintenance dose

300 mg every 4 weeks

Inadequate response

300 mg every 2 weeks

Single-dose vial, intravenous

Adult PsA/AS/nr-axSpA

Loading dose (optional)

6 mg/kg at Week 0

Maintenance dose

1.75 mg/kg every 4 weeks (maximum 300 mg per dose)

Place of Service:

Outpatient

The above policy is based on the following references:

1. Cosentyx [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; October 2024.

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.

June 07, 2025