Golimumab (Simponi and Simponi Aria)

Aetna covers golimumab (Simponi/Simponi Aria) for specified indications—RA, psoriatic arthritis (≥2 yrs), ankylosing spondylitis/non‑radiographic axial spondyloarthritis, and articular JIA—when indication‑specific criteria are met (e.g., prior biologic/targeted‑synthetic therapy or inadequate response/intolerance to appropriate conventional therapies, and RA generally must be given with methotrexate unless contraindicated). All other indications (e.g., Behçet’s, Crohn’s, non‑infectious uveitis, scleritis, asthma, sarcoidosis) and concomitant use with other biologics/targeted synthetics are considered investigational/excluded, active TB must be ruled out and biologic‑naive patients need a documented negative TB test within 6 months (latent TB must be treated before starting), with approvals subject to FDA/compendia dosing limits.

"Intravenously administered golimumab (Simponi Aria) is medically necessary for members with a documented negative tuberculosis (TB) test (PPD, IGRA, or chest x-ray) within 6 months for persons who ..."