Western Health Advantage
Enbrel (etanercept)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Quantity Limit: 30 day supply per 1 fill(s).
  • Step Therapy: ST Multiple Brands

  • Prior Authorization: Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Psoriasis (PsO):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 4
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Available through Specialty Pharmacy;
  • Ankylosing Spondylitis (AS), Rheumatoid Arthritis (RA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: Yes

    Juvenile Idiopathic Arthritis:
    Age Requirement: >= 2
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: Yes

    Psoriasis (PsO):
    Age Requirement: >= 4
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: Yes
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 10
    Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: Yes

    Psoriatic Arthritis (PsA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: Yes

  • PA Required
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