Restrictions:

• Service Line: GI, Gastroenterology
• Formulary Location: Outpatient
• Service location: Outpatient infusion, home infusion
• Patient Population: Adults
• Prior Authorization Required: Yes
• Restriction/Criteria of Use (all will apply unless specified):
  • Diagnosis of moderately to severely active Crohn’s disease OR Ulcerative Colitis
  • No hepatitis B or TB infection
    • Screening is required prior to initiating and during therapy
  • No known active infection
  • Females of childbearing potential: documentation of possible fetal risks being discussed with patients
  • Liver enzymes and bilirubin are monitored at baseline and during induction
  • Failed or intolerant to immunomodulators (i.e. azathioprine, mercaptopurine, methotrexate) or corticosteroids OR has failed or intolerant to TNF blocker or other biologic for the treatment of Crohn's disease OR Ulcerative Colitis       

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