← Back to list
Secukinumab (Cosentyx) (CPB 0905, reviewed 2026-08-11)
Effective date
Not stated in the notice
Identified
Aug 16, 2026
Summary
Aetna covers secukinumab (Cosentyx) for commercial medical plans when the criteria for the specific indication are met. The covered indications are plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, enthesitis-related arthritis, and hidradenitis suppurativa, and each has its own prior treatment and disease severity criteria. Continuation of therapy requires a positive clinical response, and intravenous Cosentyx requires precertification.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
Get Aetna alertsPolicy Monitoring is free. No card required.
What to do
Action · 8 steps
01Billing team: Obtain precertification for intravenous (IV) Cosentyx before scheduling it for applicable commercial plan designs, by calling (866) 752-7021 or faxing (888) 267-3277, and use the Statement of Medical Necessity forms.
02Confirm the prescriber is a dermatologist for plaque psoriasis, a rheumatologist or dermatologist for psoriatic arthritis and hidradenitis suppurativa, or a rheumatologist for ankylosing spondylitis, non-radiographic axial spondyloarthritis, and enthesitis-related arthritis, or that the drug is prescribed in consultation with one of them.
03For initial approval, document the criteria that apply to the indication, such as a prior biologic or targeted synthetic drug, crucial body area or body surface area involvement for plaque psoriasis, or two NSAIDs for ankylosing spondylitis.
04For continuation, document low disease activity or improvement from baseline in the signs and symptoms or body surface area that the policy lists for that indication.
05Document that the member was evaluated for tuberculosis infection before starting treatment.
06Confirm the member is not using another biologic or targeted synthetic drug for the same indication, because Aetna considers that combination experimental, investigational, or unproven.
07Check the Aetna Commercial Clinical Program Summary for preferred drugs, since commercial plans may require a trial of a lower-cost preferred drug first.
08For IV Cosentyx, follow the Utilization Management Policy on Site of Care for Specialty Drug Infusions.
Codes mentioned
J3247L40.0L40.50L40.59L73.2M08.80M08.89M45.0M45.9M45.A0M45.AB
Original notice
Secukinumab (Cosentyx) (CPB 0905, reviewed 2026-08-11)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Therapeutic Drug Monitoring of Anti-Tumor Necrosis Factor Blocking Agents (CPB 1091, reviewed 2026-10-16)MediumEffective Jan 7, 2026 · PharmacyEtanercept (CPB 0315, reviewed 2026-07-08)MediumNo effective date · Medical PolicyZoledronic Acid (CPB 0524, reviewed 2026-02-12)MediumNo effective date · Medical PolicyGolimumab (Simponi and Simponi Aria) (CPB 0790, reviewed 2026-07-31)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list