Simponi Aria® (Golimumab) Injection for Intravenous Infusion – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Simponi Aria IV for FDA‑labeled indications (active ankylosing spondylitis, active psoriatic arthritis ≥2 years, moderately‑to‑severely active rheumatoid arthritis in adults [with methotrexate], and polyarticular juvenile idiopathic arthritis ≥2 years) under the commercial medical benefit but excludes concurrent use with other targeted immunomodulators and generally treats subcutaneous Simponi as a pharmacy benefit (except certain CA plans). Coverage requires FDA‑labeled dosing, specific prior‑therapy trials or prior targeted‑therapy documentation (e.g., failure of two NSAIDs for AS, 3‑month methotrexate trial for PsA, methotrexate or a non‑biologic DMARD trial for RA), prescriber/consultation by a rheumatologist or dermatologist as specified, documentation of diagnosis and positive clinical response for continuation, and authorizations limited to ≤12 months.

"Ankylosing spondylitis (AS) — Simponi Aria is proven for the treatment of ankylosing spondylitis when criteria are met."