CurrentUnitedHealthcarePolicy N/A

Siliq (brodalumab) prior authorization

Prior authorization and coverage rules for Siliq (brodalumab) for treatment of moderate to severe plaque psoriasis under UnitedHealthcare Pharmacy Clinical Pharmacy Programs; applies to benefit plans where the program is in effect. Siliq is excluded from coverage for the majority of benefits per the policy.

Policy Summary

PayerUnitedHealthcare

PolicySiliq (brodalumab) prior authorization

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateDec 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization by documenting diagnosis of moderate to severe plaque psoriasis and history of failure or loss of response to other systemic therapies.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

excludedcoverage status for majority of benefits

12 monthsauthorization duration

plaque psoriasisFDA-indicated condition

prior failureprior therapy requirement

Coverage Criteria

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COVERAGE CRITERIA

Covered when ALL of the following are met

Initial Authorization

Diagnosis of moderate to severe plaque psoriasis
Prior therapy failure: History of failure or loss of response to other systemic therapies
No concomitant targeted immunomodulator: Patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples: Enbrel, Cimzia, Simponi, Orencia, adalimumab, Stelara, Skyrizi, Tremfya, Cosentyx, Taltz, Ilumya, Xeljanz, Olumiant, Rinvoq, Otezla)

Coverage exclusion note: Siliq is excluded from coverage for the majority of UnitedHealthcare benefits; state mandates and member-specific benefit plans may impact coverage.

COVERAGE CRITERIA (reauthorization)

Covered for reauthorization when ALL of the following are met

Reauthorization

Clinical response: Documentation of positive clinical response to Siliq therapy
No concomitant targeted immunomodulator: Patient is not receiving Siliq in combination with another systemic targeted immunomodulator (examples: Enbrel, Cimzia, Simponi, Orencia, adalimumab, Stelara, Skyrizi, Tremfya, Cosentyx, Taltz, Ilumya, Xeljanz, Olumiant, Rinvoq, Otezla)

Coverage exclusion note: Siliq is excluded from coverage for the majority of UnitedHealthcare benefits; state mandates and member-specific benefit plans may impact coverage.

Siliq (brodalumab) is excluded from coverage for the majority of UnitedHealthcare benefits. Coverage may vary for specific members based on state mandates and the member's specific benefit plan; these plan-level or state-level requirements can supersede the general exclusion. Additionally, Medical Necessity rules, supply limits and/or Step Therapy may apply per program and could affect coverage determinations.

Initial Therapy

Initial authorization requirements

Initial therapy: Diagnosis of moderate to severe plaque psoriasis; history of failure or loss of response to other systemic therapies; not used in combination with another systemic targeted immunomodulator (examples listed)

Authorization duration: 12 months

Reauthorization / Continuation Criteria

Reauthorization

Reauthorization requirements

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

Authorization duration: 12 months

Provider Actions & Approval Requirements

Prior Authorization

Prior Authorization Required — Initial Authorization

Initial authorization requires all of the following: diagnosis of moderate to severe plaque psoriasis; history of failure or loss of response to other systemic therapies; and patient is not receiving Siliq in combination with another systemic targeted immunomodulator. Authorization will be issued for 12 months.

Examples of systemic targeted immunomodulators: 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)

Prior Authorization

Prior Authorization Required — Reauthorization

Reauthorization requires documentation of a positive clinical response to Siliq and that the patient is not receiving Siliq in combination with another systemic targeted immunomodulator.

Same examples of systemic targeted immunomodulators apply as listed for initial authorization

Step Therapy

Step Therapy / Program Rules

Medical necessity rules, supply limits and/or step therapy may apply per program; specifics (including required trialed agents or supply limits) are not listed in this document. UnitedHealthcare may also approve initial or reauthorization requests based solely on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic. Note that Siliq is excluded from coverage for the majority of benefits.

Step therapy, medical necessity and supply limits may be enforced per benefit/program
Authorizations may be auto-approved based on claim/medication history and diagnosis codes

Denial Risk

Requests may be denied if Siliq is requested in combination with another systemic targeted immunomodulator or if the member's benefit excludes coverage.

Denial triggers: concurrent use with another systemic targeted immunomodulator; benefit excludes Siliq

Documentation Required

Documentation Required for Reauthorization

Documentation of positive clinical response is required for reauthorization; prior authorization may be approved based on claim/medication history when applicable.

Reauthorization requires clinical response documentation
Automated approval may use claims/medication history

Step Therapy

Step	Requirement / Note
1	Step therapy may be in place; specifics are not provided in this document. Medical Necessity and supply limits may also apply per program.

Site of Care

Note

Site of care not specified

This policy does not specify a required site of care; site-of-care requirements or infusion center settings are not addressed in this document.

Site of care not specified in this document

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 policy references that Siliq is intended for patients who have failed or lost response to other systemic therapies; prior authorization decisions may be supported by automated review of claim/medication history and diagnosis codes.

Definitions

Siliq (brodalumab) — key definition and indication facts

Drug name (generic/trade)brodalumab (Siliq)

Mechanism of action / classHuman interleukin-17 receptor A (IL-17RA) antagonist

FDA-indicated conditionModerate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy

Indication qualifiersFor patients who have failed to respond or have lost response to other systemic therapies

Typical candidate populationAdult patients with moderate to severe plaque psoriasis eligible for systemic therapy or phototherapy