CurrentColorado Rocky Mountain Health PlansPolicy 2026D0132E

Cosentyx (secukinumab) IV injection medical benefit

Defines medical necessity criteria, limitations, and billing codes for intravenous Cosentyx (secukinumab) administered by a healthcare professional for adult Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA). Notes that subcutaneous Cosentyx is generally covered under the pharmacy benefit.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCosentyx (secukinumab) IV injection medical benefit

Policy CodePolicy 2026D0132E

Change TypeRevisions to coverage rationale and example biologic lists

Effective DateJun 1, 2026

Next Review Date

Key ActionInclude justification for IV route and prescriber attestation that patient/caregiver cannot be trained or is physically unable to self-administer; document prior systemic therapies or methotrexate/NSAID trials as applicable.

SourceLink

POLICY UPDATE CHANGES

Replaced references to 'targeted immunomodulator' with 'systemic targeted immunomodulator' in Coverage Rationale.

Updated lists of example systemic targeted immunomodulators for PsA and AS/nr-axSpA; removed Olumiant (baricitinib) from PsA exclusion list and added Orencia (abatacept) and Taltz (ixekizumab) to PsA previous-treatment examples.

Updated References section to reflect most current information.

3Covered indications (IV)

3Not medically necessary (IV)

12Authorization duration (mo)

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Coverage Summary

This policy defines medical necessity criteria and limitations for intravenous (IV) Cosentyx (secukinumab) administered by a healthcare professional for adult Psoriatic Arthritis (PsA), Ankylosing Spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA). IV Cosentyx is covered with medical necessity criteria for these three indications when the specified requirements (general IV justification, prior therapy trials, dosing per U.S. FDA labeling, prescriber specialty, and combination-therapy exclusions) are met.

Subcutaneous (self-administered) Cosentyx is generally obtained under the pharmacy benefit (unless the member's plan specifies otherwise); IV administration is considered under the medical benefit when justified (prescriber must attest patient/caregiver cannot be trained or are physically unable to self-administer).

The clinical rationale notes that the effectiveness of IV Cosentyx is extrapolated from the established effectiveness of the subcutaneous formulation based on pharmacokinetic exposure (supporting the IV indications for PsA, AS, and nr-axSpA).

Policy effective date: 2026-06-01. Last review date: 2026-06-01.

General Requirements

General Requirements (Applicable to all Medical Necessity Requests/Reviews)

All requests for IV Cosentyx must include justification as to why the IV route is medically reasonable and necessary.

Prescriber must attest that the patient or caregiver are not able to be trained or are physically unable to administer Cosentyx FDA labeled for self-administration and the prescriber must submit medical records and/or justification explanation.

Psoriatic Arthritis (PsA) — Continuation of therapy: Cosentyx is proven for the treatment of psoriatic arthritis (PsA) when ALL of the following criteria are met: Documentation of positive clinical response; Cosentyx is initiated and titrated according to U.S. FDA labeled dosing for PsA; Patient is not receiving Cosentyx in combination with a systemic targeted immunomodulator (e.g., adalimumab, Bimzelx [bimekizumab-bkzx], Cimzia [certolizumab], Enbrel [etanercept], Orencia [abatacept], Otezla [apremilast], Rinvoq [upadacitinib], Simponi [golimumab], Skyrizi [risankizumab], Taltz [ixekizumab], Tremfya [guselkumab], Xeljanz/Xeljanz XR [tofacitinib], ustekinumab) for treatment of the same indication; Authorization will be issued for 12 months.

Ankylosing Spondylitis (AS) and Non-Radiographic Axial Spondyloarthritis (nr-axSpA) — Initial therapy: Cosentyx is proven for the treatment of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) when ALL of the following criteria are met: Diagnosis of active ankylosing spondylitis or non-radiographic axial spondyloarthritis; One of the following: history of failure to two NSAIDs (each used at maximally indicated doses for at least 4 weeks unless contraindicated or not tolerated) OR prior treatment with a systemic targeted immunomodulator FDA-approved for AS or nr-axSpA (document drug, date, and duration of therapy); Cosentyx is initiated and titrated according to U.S. FDA labeled dosing for AS or nr-axSpA; Patient is not receiving Cosentyx in combination with a systemic targeted immunomodulator (e.g., adalimumab, Bimzelx [bimekizumab-bkzx], Cimzia [certolizumab], Enbrel [etanercept], Olumiant [baricitinib], Orencia [abatacept], Simponi [golimumab], Rinvoq [upadacitinib], Taltz [ixekizumab], Xeljanz [tofacitinib]) for treatment of the same indication; Prescribed by or in consultation with a rheumatologist; Initial authorization will be issued for 12 months.

Ankylosing Spondylitis (AS) and Non-Radiographic Axial Spondyloarthritis (nr-axSpA) — Continuation of therapy: Cosentyx is proven for continuation when ALL of the following criteria are met: Documentation of positive clinical response; Cosentyx is initiated and titrated according to U.S. FDA labeled dosing for AS or nr-axSpA; Patient is not receiving Cosentyx in combination with a systemic targeted immunomodulator (e.g., adalimumab, Bimzelx [bimekizumab-bkzx], Cimzia [certolizumab], Enbrel [etanercept], Olumiant [baricitinib], Orencia [abatacept], Simponi [golimumab], Rinvoq [upadacitinib], Taltz [ixekizumab], Xeljanz [tofacitinib]) for treatment of the same indication; Authorization will be issued for 12 months.

Not medically necessary / Unproven (IV Cosentyx): Cosentyx (secukinumab) for intravenous injection is unproven and not medically necessary for the following indications: Plaque psoriasis; Enthesitis-related arthritis; Hidradenitis suppurativa. (Note: Cosentyx for self-administered subcutaneous injection is obtained under the pharmacy benefit unless otherwise specified in the member's benefit plan.)

Psoriatic Arthritis (PsA) — Initial Therapy

Psoriatic Arthritis (PsA) — Initial therapy

All requests for IV Cosentyx must meet the following:

ALL of the following

Request must include justification why the IV route is medically reasonable and necessary.
Prescriber must attest that patient or caregiver are not able to be trained or are physically unable to administer Cosentyx FDA labeled for self-administration; prescriber must submit medical records and/or justification explanation.

ref": "b1_0

title": "General Requirements (Applicable to all Medical Necessity Requests/Reviews)"

Psoriatic Arthritis (PsA) — Continuation of Therapy

Ankylosing Spondylitis (AS) and Non‑radiographic Axial Spondyloarthritis (nr‑axSpA) — Initial Therapy

Ankylosing Spondylitis (AS) and nr‑axSpA — Continuation of Therapy

Not Medically Necessary / Unproven Indications

Applicable Codes

Drug HCPCSHCPCSCovered

J3247

Injection, secukinumab, IV, 1 mg

Applicable ICD-10-CM / ICD-9-CM (diagnoses listed)ICD-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.

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Provider Actions & Documentation Requirements

Prior Authorization

Prior authorization required for IV Cosentyx

IV Cosentyx requires prior authorization. Requests must justify why the IV route is medically reasonable and necessary and include a prescriber attestation that the patient or caregiver cannot be trained or is physically unable to self-administer the FDA‑labeled product. Initial and continuation authorizations are issued for 12 months.

J3247

Documentation Required

Document prior treatment history

For initial therapy, document prior treatment history as applicable: a 3‑month trial of methotrexate at maximally indicated dose (PsA) unless contraindicated or prior treatment with a systemic targeted immunomodulator for PsA; or failure of two NSAIDs, each for at least 4 weeks, or prior treatment with a systemic targeted immunomodulator for AS/nr‑axSpA. Include drug name, dates, and duration of therapy; submit medical records and/or claims history to support these prior treatments.

Submit medical records or claims history documenting prior therapies (drug name, dates, duration)

Background & Clinical Rationale

Cosentyx (secukinumab) is a human IgG1 monoclonal antibody that selectively binds to interleukin-17A (IL-17A) and inhibits its interaction with the IL-17 receptor, reducing the release of proinflammatory cytokines and chemokines.

The IV formulation's effectiveness for adult patients with active PsA, AS, and nr-axSpA was extrapolated from the established effectiveness of subcutaneous Cosentyx based on pharmacokinetic exposure, providing the clinical rationale for IV use for these indications under the medical benefit.

Note: subcutaneous (self-administered) Cosentyx is generally covered under the pharmacy benefit unless otherwise specified in the member's plan documents.

Definitions and Evidence (brief/exact wording)

Definition - Systemic targeted immunomodulatorReferenced examples include biologic and targeted small-molecule therapies (e.g., adalimumab, bimekizumab, certolizumab, etanercept, abatacept, apremilast, upadacitinib, golimumab, risankizumab, ixekizumab, guselkumab, tofacitinib, ustekinumab, baricitinib).

FDA indications (IV)Active psoriatic arthritis; active ankylosing spondylitis; active non-radiographic axial spondyloarthritis with objective signs of inflammation

Supporting clinical rationale

Revision History

06/01/2026revisedLatest

Replaced references to 'targeted immunomodulator' with 'systemic targeted immunomodulator' in Coverage Rationale.

06/01/2026revisedLatest

Updated lists of example systemic targeted immunomodulators for PsA and AS/nr-axSpA: removed Olumiant (baricitinib) from PsA exclusion list; added Orencia (abatacept) and Taltz (ixekizumab) to PsA previous-treatment examples; added Cimzia (certolizumab), Enbrel (etanercept), Olumiant (baricitinib), Orencia (abatacept), and Taltz (ixekizumab) to AS/nr-axSpA previous-treatment examples; adjusted Xeljanz nomenclature.