Limited Coverage Drugs - Certolizumab for the treatment of Psoriatic Arthritis

Generic Name

certolizumab

Strength

200mg/mL
Form subcutaneous injection solution

Special Authority Criteria

Approval Period

For the treatment of Psoriatic Arthritis according to established criteria described in Special Authority Request forms 5360 (Initial/Switch) and 5361 (Renewal), below.

Coverage of certolizumab for the treatment of Psoriatic Arthritis is available only when certolizumab is prescribed by a rheumatologist.

1 year

Practitioner Exemptions

  • None

Special Notes

  • None

Special Authority Request Form(s)

Click on the appropriate Special Authority Form below for full criteria.