Certolizumab Pegol (Cimzia)

Aetna covers certolizumab pegol (Cimzia) for adults with moderate–severe RA (with or without methotrexate), active PsA, AS and nr‑axSpA, moderate–severe Crohn’s disease, and moderate–severe chronic plaque psoriasis when criteria are met, but restricts Cimzia to patients who have a contraindication, intolerance, or inadequate response to specified lower‑cost targeted immune modulators (for plaque psoriasis this applies to all members; for other indications it applies to members new to targeted immune modulator therapy). Prior authorization is required, and—unless pregnant/breastfeeding or contraindicated—Aetna requires one‑month trials of the specified lower‑cost agents (Simponi Aria AND Avsola or Inflectra for RA, PsA and axial spondyloarthritis; Ilumya AND Avsola or Inflectra for plaque psoriasis) before approving Cimzia.

"Moderately to severely active rheumatoid arthritis (RA) in adults (including use as combination therapy with methotrexate or as monotherapy) when criteria below are met."