Remicade for ulcerative colitis - policy criteria

[chantell.reagan]

Based on the popularity of our previous analyses, we extended the review of biologic agents to ulcerative colitis (UC). The latest treatment guidelines in this therapeutic area were issued by the American Gastroenterolgical Association (AGA) in 2006. Additionally the National Institute for Health and Clinical Excellence (NICE) in the UK recently published a technology appraisal in 12/08, positioning Remicade after failure of cyclosporine. According to both of these guidelines, Remicade is reserved for use after conventional therapy in patients with acute exacerbations of UC.

Our analysis of UC policies issued by 7 plans showed that most plans require failure of conventional therapy prior to the initiation of Remicade.

The following figure provides a comparative summary of the selected policies (click on the image to enlarge it).


Sources:

Blue Cross and Blue Shield of Florida. Medical coverage guidelines

The Regence Group. Remicade policy

Excellus BlueCross BlueShield. Remicade policy

BlueCross BlueShield of Alabama. TNF Antagonists and Other Biologics for Rheumatologic Diseases: Remicade policy

Wellpoint, NextRx. Remicade policy

Aetna. Clinical Policy Bulletin: Remicade

Cigna. Remicade Coverage Position