CurrentUnitedHealthcarePolicy N/A

Siliq (brodalumab) prior authorization

Controls prior authorization and reauthorization criteria for Siliq (brodalumab) for treatment of moderate to severe plaque psoriasis for UnitedHealthcare members; applies to benefits where pharmacy clinical programs are in effect.

Policy Summary

PayerUnitedHealthcare

PolicySiliq (brodalumab) prior authorization

Policy CodePolicy N/A

Change TypeExclusions addedexamples clarified

Effective DateDec 1, 2025

Next Review DateOct 1, 2025

Key ActionSubmit documentation of diagnosis and prior treatment failure for initial authorization and documentation of positive clinical response for reauthorization.

SourceLink

POLICY UPDATE CHANGES

Added statement that Siliq is excluded from coverage for the majority of our benefits.

Added 'systemic' to clarify examples with no change to clinical intent.

Updated examples of other systemic targeted immunomodulators and added Rinvoq to examples.

prior authprogram type

excludedcoverage status (majority)

mod‑to‑sev psoriasisindicated condition

12 monthsauthorization duration

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Coverage Criteria

inv-01: Initial Therapy — Covered when ALL of the following are met for initial authorization

Covered when ALL of the following are met for initial authorization:

Initial Authorization for Siliq: (1) Diagnosis of moderate to severe plaque psoriasis; (2) History of failure or loss of response to other systemic therapies; (3) Patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples listed in policy).

Authorization will be issued for 12 months

inv-02: Continuation Therapy / Reauthorization — Covered for reauthorization when BOTH of the following are met

Covered for reauthorization when BOTH of the following are met:

Reauthorization for Siliq: (1) Documentation of positive clinical response to Siliq therapy; (2) Patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples listed in policy).

Authorization will be issued for 12 months

Siliq (brodalumab) is excluded from coverage for the majority of our benefits. This exclusion is stated in the UnitedHealthcare Pharmacy Clinical Pharmacy Programs summary and reiterated in the Additional Clinical Rules. Where coverage is available, prior authorization and other utilization management rules (for example, medical necessity determinations, supply limits, or Step Therapy) may still apply.

Initial Therapy

inv-10: Initial Therapy — initial authorization criteria

Initial authorization criteria

Initial Authorization: Diagnosis of moderate to severe plaque psoriasis; history of failure or loss of response to other systemic therapies; patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples listed in policy).

Authorization will be issued for 12 months

Continuation / Reauthorization

inv-11: Reauthorization — reauthorization requirements

Reauthorization requirements

Reauthorization: Documentation of positive clinical response to Siliq therapy AND patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples listed in policy).

Authorization will be issued for 12 months

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization required. Provider must document diagnosis of moderate to severe plaque psoriasis and prior failure or loss of response to other systemic therapies. Authorization will be issued for 12 months.

Diagnosis: moderate to severe plaque psoriasis
Prior therapy: history of failure or loss of response to other systemic therapies
Authorization duration: 12 months

Denial Risk

Concurrent Therapy Exclusion — Denial Risk

Requests may be denied if the patient is receiving Siliq in combination with another systemic targeted immunomodulator. Examples include but are not limited to Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Stelara (ustekinumab), Skyrizi (risankizumab), Tremfya (guselkumab), Cosentyx (secukinumab), Taltz (ixekizumab), Ilumya (tildrakizumab), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib), Otezla (apremilast).

Step Therapy and Utilization Management

Step	Requirement
1
Step Therapy may be in place as part of Medical Necessity and utilization management; Medical Necessity, supply limits and/or Step Therapy may be in place per program.

Background

Siliq (brodalumab) is a human interleukin-17 receptor A (IL-17RA) antagonist indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy. The agent is used as a systemic therapy for plaque psoriasis.

Definitions

Siliq (brodalumab) — definition and indication

Drug classHuman interleukin-17 receptor A (IL-17RA) antagonist

Generic / brandbrodalumab (Siliq)

IndicationTreatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy

Treatment contextFor patients who have failed to respond or have lost response to other systemic therapies

Clinical useSystemic therapy for plaque psoriasis