Cimzia® (Certolizumab Pegol) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Cimzia (certolizumab pegol) for its FDA‑approved inflammatory indications (Crohn’s disease, RA, PsA, AS/nr‑axSpA, plaque psoriasis, and polyarticular JIA) when dosed per the FDA label and not used in combination with specified targeted immunomodulators. Approval requires indication‑specific prior therapy trials or prior biologic use (e.g., conventional therapy or DMARD/methotrexate failure, two NSAID trials for axSpA, severity criteria for psoriasis), appropriate specialist prescribing/consultation, documentation of dosing and positive clinical response for renewal, and authorizations are typically for 12 months.

"Dosing requirement: "Cimzia is initiated and titrated according to US FDA labeled dosing" (required for initiation and for continuation in multiple indications)"

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