Limited coverage criteria – secukinumab for Ps, AS, PsA

secukinumab

150 mg/mL pre-filled pen
150 mg/mL pre-filled syringe
300 mg/2 mL pre-filled pen
300 mg/2 mL pre-filled syringe

For the treatment of moderate to severe plaque psoriasis, according to established criteria described in Special Authority request form HLTH 5380 – Targeted Therapies for Plaque Psoriasis (PDF, 798KB)

Coverage of secukinumab for the treatment of plaque psoriasis is only available when a Special Authority request is submitted by a dermatologist

For the treatment of ankylosing spondylitis, according to established criteria described in Special Authority request forms:

• Initial/switch: HLTH 5365 – Targeted DMARDs for Ankylosing Spondylitis: Initial/Switch (PDF, 817KB)
• Renewal: HLTH 5366 – Targeted DMARDs for Ankylosing Spondylitis: Renewal (PDF, 820KB) 

Coverage of secukinumab for the treatment of ankylosing spondylitis is only available when a Special Authority request is submitted by a rheumatologist

For the treatment of psoriatic arthritis, according to established criteria described in Special Authority request forms:

• Initial/switch: HLTH 5360 – Targeted DMARDs for Psoriatic Arthritis: Initial/Switch (PDF, 839KB)
• Renewal: HLTH 5361 – Targeted DMARDs for Psoriatic Arthritis: Renewal (PDF, 831KB)

Coverage of secukinumab for the treatment of psoriatic arthritis is only available when a Special Authority request is submitted by a rheumatologist