Rheumatoid Arthritis [for Actemra, Cimzia, Enbrel, Humira, Inflectra, Kineret, Orencia, Remicade, Simponi, Simponi Aria, Xeljanz, Xeljanz XR]
- Diagnosis of rheumatoid arthritis (RA)
AND
- Confirmed by a Rheumatologist
OR
- Defined at baseline prior to disease modifying anti-rheumatic drug (DMARD) treatment initiation by the (American College of Rheumatology (ACR)) criteria (refer to General Information for ACR criteria)
AND
- Failure or clinically significant adverse effects to methotrexate (MTX) in the last year for patients who are new to biologics
OR
- If patient is not a candidate for MTX (i.e., patient is a smoker [increased risk of MTX lung disease] or MTX is contraindicated), then failure or clinically significant adverse effect to sulfasalazine or 1 other DMARD
AND [for Kineret, Cimzia, Orencia, Actemra, Enbrel, Xeljanz, Xeljanz XR, Inflectra]
- Failure or clinically significant adverse effects to a 3-month minimum trial of HumiraR AND either, RemicadeR, or SimponiR or Simponi AriaR)
Psoriatic Arthritis [for Cimzia, Cosentyx, Enbrel, Humira, Inflectra, Otezla, Remicade Simponi, Stelara]
- Diagnosis of Active Psoriatic Arthritis
AND
- Confirmed by a Rheumatologist or Dermatologist
AND
- Failure or clinically significant adverse effects to MTX unless contraindicated
AND [for Cimzia, Cosentyx, Enbrel, Inflectra]
- Failure or clinically significant adverse effects to a 3-month minimum trial of HumiraR AND either, RemicadeR, StelaraR, SimponiR or Otezla
Ankylosing Spondylitis [for Cimzia, Cosentyx, Enbrel, Humira, Inflectra, Remicade, Simponi]
- Diagnosis of active Ankylosing Spondylitis
AND
- Failure or clinically significant adverse effects to at least two NSAIDs for at least 1 month at maximal recommended or tolerated anti-inflammatory dose, unless contraindicated
AND [for Cimzia, Enbrel, Cosentyx, Inflectra]
- Failure or clinically significant adverse effects to a 3-month minimum trial of HumiraR AND either, RemicadeR or SimponiR)
Crohn`s Disease [for Cimzia, Entyvio, Humira, Inflectra, Remicade, Stelara, Tysabri]
- Diagnosis of moderate to severe Crohn`s Disease
AND
- Confirmed by a gastroenterologist
AND [for Cimzia, Entyvio, Tysabri, Inflectra]
- Failure or clinically significant adverse effects to HumiraR AND either RemicadeR OR Stelara
Ulcerative Colitis [for Entyvio, Humira, Inflectra, Remicade, Simponi]
- Diagnosis of moderate to severe ulcerative colitis
AND
- Confirmed by a gastroenterologist
AND
For Induction:
- Patient is not in remission
AND
- Failure or clinically significant adverse effects to a one-month course of aminosalicylates (e.g. sulfasalazine, mesalamine) followed by corticosteroids such as prednisone.
AND [for Entyvio, Inflectra]
- Failure or clinically significant adverse effects to HumiraR AND RemicadeR or Simponi
For maintenance:
- Failure or clinically significant adverse effects to one of the following:
- azathioprine
- 6-mercaptopurine (6-MP)
- aminosalicylates (e.g., sulfasalazine)
Plaque Psoriasis [for Cosentyx, Enbrel, Humira, Inflectra, Otezla, Remicade, Stelara, Taltz]
- Diagnosis of chronic moderate to severe plaque psoriasis
AND
- Prescribed by a Dermatologist or Rheumatologist
AND
- Failure or clinically significant adverse effects to ONE of the following therapies either alone or in combination, unless contraindicated:
- Methotrexate up to a dose of 15-20 mg/week
OR
- If methotrexate is contraindicated, failure or clinically significant adverse effects to PUVA Therapy or UVB, or cyclosporine or acitretin
AND [for Enbrel]
- Failure or clinically significant adverse effects to HumiraR AND either Stelara, RemicadeR, or Otezla
OR [for Cosentyx, Taltz, Inflectra]
- Failure or clinically significant adverse effects to Humira AND either Stelara or Remicade
Polyarticular Juvenile Idiopathic Arthritis [for Actemra, Enbrel, Humira, Orencia (IV only)]
- Diagnosis of Active Polyarticular Juvenile Idiopathic Arthritis
AND
- Confirmed by a Rheumatologist
AND
- Failure or clinically significant adverse effects to methotrexate for 3 months
AND [for Orencia, Enbrel]
- Failure or clinically significant adverse effects to HumiraR
Neonatal-Onset Multisystem Inflammatory Disease (NOMID) [for Kineret only]
- Diagnosis of Neonatal-onset multisystem inflammatory disease (NOMID) or chronic infantile neurological, cutaneous and articular syndrome (CINCA)
Hidradenitis Suppurativa (HS) [for Humira, Enbrel]:
- Diagnosis of Hidradenitis Suppurativa (HS)
AND
- Prescribed by a Dermatologist or Rheumatologist or gastroenterologist
AND
- Documentation of Hurley stage II or stage III
AND
- Failure or clinically significant adverse effects to systemic antibiotic therapy unless intolerant or contraindicated
AND [for Enbrel]
- Failure or clinically significant adverse effects to HumiraR
Systemic juvenile idiopathic arthritis (SJIA) (for Actemra only):
- Diagnosis of Systemic juvenile idiopathic arthritis
AND
- Prescribed by a Dermatologist or Rheumatologist or gastroenterologist
Non-infectious Uveitis (UV) [for Humira only]:
- Diagnosis of non-infectious intermediate, posterior, or panuveitis
AND
- Prescribed by an ophthalmologist or rheumatologist
AND
- Failure or clinically significant adverse effects to oral corticosteroids (e.g., prednisone)
AND
- Failure or clinically significant adverse effects to non-biologic immunosuppressive therapy (e.g., azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, cyclophosphamide, chlorambucil)
Relapsing remitting multiple sclerosis (for Tysabri only)
- Refer to Tysabri MS criteria.