Adalimumab

Adalimumab (Humira) and listed biosimilars are covered for their FDA‑labeled inflammatory/autoimmune indications (RA, JIA, PsA, AS/nr‑axSpA, Crohn’s, UC, uveitis, HS, plaque psoriasis, etc.), though some biosimilars lack specific pediatric or indication approvals; the drug must not be given for active TB. Coverage requires a documented negative TB test within 6 months for biologic/targeted‑synthetic–naive patients (positive tests mandate chest imaging and treatment of latent TB before initiation), prescribing by or in consultation with the appropriate specialist, compliance with indication‑specific age limits, and prior inadequate response/intolerance to specified conventional therapies with required trial durations.

"Adalimumab (Humira or generic) and listed biosimilars medically necessary for the following indications where the member has a documented negative tuberculosis (TB) test (which can include a PPD or..."