We extended the review of biologic agents in rheumatoid arthritis (RA) to include recently-approved TNF-blockers, Cimzia (certolizumab pegol) and Simponi (golimumab). We analyzed 15 regional and national plans, 7 of which have publically available policies pertinent to this update. The following are our key findings:
•2/7 plans allow first-line use of TNF-blockers
•5/7 plans apply the same criteria for Cimzia and/or Simponi as for other TNF-blockers
•1/7 plans requires failure of a DMARD and a TNF-blocker before initiating Orencia
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Additional sources:
Aetna. Clinical Policy Bulletin: Cimzia: (see full link in the attached tabulated analysis)
Atena. Clinical Policy Bulletin: Enbrel: (see full link in the attached tabulated analysis)
Aetna. Clinical Policy Bulletin: Humira: (see full link in the attached tabulated analysis)
Aetna. Clinical Policy Bulletin: Orencia: (see full link in the attached tabulated analysis)
Aetna. Clinical Policy Bulletin: Remicade: (see full link in the attached tabulated analysis)
Aetna. Clinical Policy Bulletin: Rituxan: (see full link in the attached tabulated analysis)
Aetna. Clinical Policy Bulletin: Simponi: (see full link in the attached tabulated analysis)
BlueCross Blue Shield of Alabama. Cimzia coverage criteria: (see full link in the attached tabulated analysis)
BlueCross BlueShield of Alabama. Enbrel coverage criteria: (see full link in the attached tabulated analysis)
BlueCross BlueShield of Alabama. Humira coverage criteria: (see full link in the attached tabulated analysis)
BlueCross Blue Shield of Alabama. Simponi coverage criteria: (see full link in the attached tabulated analysis)
BlueCross BlueShield of Alabama. TNF Antagonists and Other Biologics for Rheumatologic Diseases: Medical policy: (see full link in the attached tabulated analysis)
BlueCross BlueShield of Alabama. Rituxan policy: (see full link in the attached tabulated analysis)
Blue Cross and Blue Shield of Florida. Medical coverage guidelines: (see full link in the attached tabulated analysis)
Excellus Clinical Review Prior Authorization (Orencia, Simponi): (see full link in the attached tabulated analysis)
Excellus Cimzia policy: (see full link in the attached tabulated analysis)
Excellus Enbrel policy: (see full link in the attached tabulated analysis)
Excellus Humira policy: (see full link in the attached tabulated analysis)
Excellus Remicade policy: (see full link in the attached tabulated analysis)
Excellus Rituxan policy: (see full link in the attached tabulated analysis)
The Regence Group. Cimzia policy: (see full link in the attached tabulated analysis)
The Regence Group. Enbrel policy: (see full link in the attached tabulated analysis)
The Regence Group. Humira policy: (see full link in the attached tabulated analysis)
The Regence Group. Orencia policy: (see full link in the attached tabulated analysis)
The Regence Group. Remicade policy: (see full link in the attached tabulated analysis)
The Regence Group. Simponi policy: (see full link in the attached tabulated analysis)
UnitedHealthcare, Oxford: Cimzia policy: (see full link in the attached tabulated analysis)
United Healthcare, Oxford: Enbrel policy: (see full link in the attached tabulated analysis)
United Healthcare, Oxford. Humira policy: (see full link in the attached tabulated analysis)
United Healthcare, Oxford, Orencia policy: (see full link in the attached tabulated analysis)
United Healthcare, Oxford. Remicade policy: (see full link in the attached tabulated analysis)
United Healthcare, Oxford: Simponi policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Cimzia policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Enbrel policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Orencia policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Humira policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Remicade policy: (see full link in the attached tabulated analysis)
Wellpoint, NextRx. Simponi policy: (see full link in the attached tabulated analysis)