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Symponi Will Require Prior Review October 1, 2009

Effective October 1, 2009, Symponi (golimumab injection) will require prior review/certification. Symponi is a self-administered tumor necrosis factor (TNF) blocker recently approved for rheumatoid and psoriatic arthritis, as well as ankylosing spondylitis.

Effective October 1, coverage will be provided for this drug for the following conditions and indications:

  • Rheumatoid or Psoriatic Arthritis when a patient has experienced a therapeutic failure/inadequate response with methotrexate, OR is unable to receive methotrexate (e.g. use of methotrexate is contraindicated in the patient); OR Rheumatoid or Psoriatic Arthritis is rapidly progressive and advancing.
  • Ankylosing Spondylitis

Please note that coverage of Simponi will not be provided for use in combination with Kineret, Orencia, Remicade, Enbrel, Cimzia, or Humira. For all covered indications, the provider must consider and screen the patient for the presence of latent tuberculosis (TB) infection.