Golimumab (Simponi Aria®)
EVICORE-MEDICAL_DRUG-90249248
Simponi Aria (golimumab) is covered only for FDA‑approved indications (adult rheumatoid arthritis, psoriatic arthritis, adult ankylosing spondylitis, and polyarticular juvenile idiopathic arthritis) and is not authorized for non‑FDA indications. Approval requires indication‑specific prior therapy (RA: 3 months of a biologic or 3 months of a conventional synthetic DMARD; JIA: trial of one other agent or documented aggressive disease), prescription by or consultation with the required specialist (rheumatologist, or rheumatologist/dermatologist for psoriatic arthritis), adherence to IV dosing (weeks 0 and 4, then no more frequently than every 8 weeks; adults up to 2 mg/kg, pediatrics up to 80 mg/m2), initial authorization for 3 months with 12‑month renewal contingent on documented clinical response and meeting safety criteria.
"Simponi Aria is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis."