Secukinumab (Cosentyx) (CPB 0905, reviewed 2026-08-11)

IMMEDIATE ACTION REQUIRED: Billing team must implement the following changes: (1) For ALL Aetna commercial plan claims for IV Cosentyx, implement mandatory prior authorization by calling (866) 752-7021 or faxing (888) 267-3277 before claim submission—claims without precertification will be denied. (2) Update billing system to enforce prescriber specialty requirements: dermatologist for plaque psoriasis; rheumatologist or dermatologist for psoriatic arthritis/hidradenitis suppurativa; rheumatologist for ankylosing spondylitis/non-radiographic axial spondyloarthritis/enthesitis-related arthritis. (3) For plaque psoriasis, psoriatic arthritis, and hidradenitis suppurativa, update authorization templates to require documentation of prior biologic/targeted synthetic drug trial OR specific clinical criteria (BSA involvement, crucial body area involvement, NSAID failure, intolerance, or contraindication). (4) For ankylosing spondylitis, non-radiographic axial spondyloarthritis, and enthesitis-related arthritis, require documentation of inadequate response or intolerance to at least two NSAIDs before authorization. (5) Update continuation-of-therapy protocols to require baseline vs. current documentation of clinical response metrics (e.g., BSA reduction, CRP improvement, joint swelling, functional status). (6) Reference the Specialty Pharmacy Precertification portal for Statement of Medical Necessity forms. (7) Ensure compliance with Site of Care Utilization Management Policy for IV Cosentyx administration. Failure to obtain precertification will result in claim denials; failure to verify specialist credentials will result in claim rejections.