Secukinumab

This policy covers secukinumab (Cosentyx) therapy for specified adult inflammatory conditions—including moderate-to-severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non‑radiographic axial spondyloarthritis and related manifestations such as enthesitis, dactylitis, nail disease, and ocular inflammation—when treatment and dosing are consistent with accepted standards (e.g., FDA labeling, recognized compendia, clinical guidelines). Coverage is limited to adults (≥18), off‑label uses require support from two peer‑reviewed articles, IV use is considered experimental/investigational for non‑FDA indications, self‑administered dosing falls under the pharmacy benefit, and actual coverage may vary by member benefit plan and state (applies to HCSC members in Ohio).

"Therapy is covered when it is proven effective for the relevant diagnosis according to current generally accepted standards of practice."