CurrentColorado Rocky Mountain Health PlansPolicy 2026D0132E

Cosentyx (secukinumab) IV — Medical Benefit Coverage Criteria

Defines medical necessity criteria, authorization expectations, and coding for intravenous (IV) Cosentyx (secukinumab) under the medical benefit for adult PsA, AS, and non-radiographic axial spondyloarthritis.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCosentyx (secukinumab) IV — Medical Benefit Coverage Criteria

Policy CodePolicy 2026D0132E

Change TypeRevised (examples updatedterminology clarified)

Effective DateJun 1, 2026

Next Review Date

Key ActionSubmit prior authorization with justification for IV route and prescriber attestation that the patient/caregiver cannot self-administer; authorizations are issued for 12 months when criteria are met.

SourceLink

POLICY UPDATE CHANGES

Updated lists of example systemic targeted immunomodulators for PsA and AS/nr-axSpA (additions and removals noted).

Replaced references to 'targeted immunomodulator' with 'systemic targeted immunomodulator'.

Updated References section to reflect most current information.

12 monthsauthorization length

3 conditionsmedically necessary indications

J3247primary HCPCS

3not medically necessary

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Coverage Criteria for IV Cosentyx (secukinumab)

Psoriatic Arthritis (PsA)

Covered when ALL of the following are met

PsA Initial Therapy: Diagnosis of active psoriatic arthritis

PsA Initial Therapy: Cosentyx is initiated and titrated according to U.S. FDA labeled dosing for PsA

PsA Initial Therapy - prior therapy: Either history of failure to a 3-month trial of methotrexate at the maximally indicated dose (unless contraindicated or clinically significant adverse effects) OR prior treatment with a systemic targeted immunomodulator FDA‑approved for psoriatic arthritis (document drug, date, and duration)>= 3 months for methotrexate trial

Examples of systemic targeted immunomodulators are listed in policy (e.g., adalimumab, bimekizumab, certolizumab, etanercept, abatacept, apremilast, upadacitinib, golimumab, risankizumab, ixekizumab, guselkumab, tofacitinib, ustekinumab)

PsA Initial Therapy: Patient is not receiving Cosentyx in combination with a systemic targeted immunomodulator for the same indication

Examples of systemic targeted immunomodulators are listed in policy

PsA Initial Therapy: Prescribed by or in consultation with a rheumatologist or dermatologist

PsA Continuation Therapy: Documentation of positive clinical response

Cosentyx dosing must continue per FDA labeling and patient must not be receiving Cosentyx in combination with a systemic targeted immunomodulator for the same indication

Ankylosing Spondylitis (AS) and Non-Radiographic Axial Spondyloarthritis (nr-axSpA)

Covered when ALL of the following are met

AS/nr-axSpA Initial Therapy: Diagnosis of active ankylosing spondylitis or non-radiographic axial spondyloarthritis

AS/nr-axSpA Initial Therapy - prior therapy: Either history of failure to two NSAIDs at maximally indicated doses (each used at least 4 weeks) OR prior treatment with a systemic targeted immunomodulator FDA‑approved for ankylosing spondylitis or nr-axSpAEach NSAID >= 4 weeks

Examples of systemic targeted immunomodulators are listed in policy (e.g., adalimumab, bimekizumab, certolizumab, etanercept, baricitinib, abatacept, golimumab, upadacitinib, ixekizumab, tofacitinib)

AS/nr-axSpA Initial Therapy: Cosentyx is initiated and titrated according to U.S. FDA labeled dosing for AS or nr-axSpA

IV Cosentyx (secukinumab) is explicitly identified in the policy as unproven and not medically necessary when used for the following conditions: plaque psoriasis, enthesitis-related arthritis, and hidradenitis suppurativa. These indications are outside the medical-benefit coverage criteria for IV administration and should be routed to the pharmacy benefit when appropriate (subcutaneous Cosentyx is covered under the pharmacy benefit).

Use of intravenous Cosentyx (secukinumab) for plaque psoriasis, enthesitis-related arthritis, and hidradenitis suppurativa is considered not medically necessary under this policy.

Applicable Codes and Coding Rules

Applicable HCPCSHCPCS

J3247

Injection, secukinumab, IV, 1 mg

Applicable ICD-10 Diagnosis CodesICD-10

L40.50	Arthropathic psoriasis, unspecified
L40.51	Distal interphalangeal psoriatic arthropathy
L40.52	Psoriatic arthritis mutilans
L40.53	Psoriatic spondylitis
L40.54	Psoriatic juvenile arthropathy
L40.59	Other psoriatic arthropathy
M08.1	Juvenile ankylosing spondylitis
M45.0	Ankylosing spondylitis of multiple sites in spine
M45.1	Ankylosing spondylitis of occipito-atlanto-axial region
M45.2	Ankylosing spondylitis of cervical region

1–10 of 27

1/3

inv-07: Methotrexate trial length for PsA — threshold and exception notes

Threshold>= 3 months of methotrexate at the maximally indicated dose

ExceptionShorter duration acceptable if methotrexate is contraindicated or clinically significant adverse effects are experienced

Documentation requiredDocument drug, dates, and duration of methotrexate trial in medical records or claims history

inv-08: NSAID trial requirement for AS/nr-axSpA — failure of two NSAIDs each ≥ 4 weeks at maximally indicated doses

ThresholdFailure of two NSAIDs, each used for at least 4 weeks at maximally indicated doses

Examples

Prior Authorization, Documentation, and Operational Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for IV Cosentyx. Typical initial and renewal authorizations are issued for 12 months when criteria are met.

Initial and renewal authorization length: 12 months

Documentation Required

Required Documentation

Requests must include documentation that justifies use of the IV route over the FDA‑labeled self‑administered formulation and a prescriber attestation regarding inability to self‑administer. Submit relevant medical records or narrative explaining why the patient or caregiver cannot be trained or is physically unable to administer Cosentyx per FDA labeling.

Required documentation: diagnosis and indication; dosing consistent with FDA labeling for the specified indication; documentation of failed prior therapies or prior use of systemic targeted immunomodulators when applicable (drug name, dates, duration); clinical notes supporting inability to self‑administer or train caregiver; prescriber attestation that patient/caregiver cannot self‑administer; documentation of positive clinical response for continuation requests; supporting labs/imaging if relevant.

Definitions and Drug Identification

inv-14: Cosentyx — drug name mapping (Cosentyx / secukinumab)

Brand nameCosentyx

Generic namesecukinumab

Drug classHuman IgG1 monoclonal antibody targeting interleukin-17A (IL-17A)

inv-15: FDA indication (informational) — listed FDA-indicated conditions for secukinumab

FDA-indicated condition 1Adult patients with active psoriatic arthritis

FDA-indicated condition 2Adult patients with active ankylosing spondylitis

FDA-indicated condition 3

Background

Cosentyx (secukinumab) is a human IgG1 monoclonal antibody that selectively binds to interleukin-17A (IL-17A), inhibiting its interaction with the IL-17 receptor and reducing downstream proinflammatory cytokine and chemokine release. The policy covers IV administration of Cosentyx for certain adult rheumatologic indications when FDA dosing and prior-therapy requirements are met; effectiveness of the IV formulation for psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis is extrapolated from the subcutaneous formulation based on pharmacokinetic exposure. Cosentyx is listed in the policy as the product name (Cosentyx) and is described by its FDA informational indication as a human interleukin-17A antagonist for the specified adult indications.