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Limited coverage criteria – certolizumab

Last updated on February 28, 2025

Generic name

 certolizumab

Strength & form

 200 mg/mL subcutaneous injection solution

Special Authority criteria

Approval period

Ankylosing spondylitis

For the treatment of ankylosing spondylitis according to established criteria (indicated on the Special Authority form below) when a Special Authority request is submitted by a rheumatologist.

First approval: 1 year

Renewal: 1 year or indefinite

Psoriatic arthritis

For the treatment of psoriatic arthritis according to established criteria (indicated on the Special Authority form below) when a Special Authority request is submitted by a rheumatologist.

First approval: 1 year

Renewal: 1 year or indefinite

Rheumatoid arthritis

For the treatment of rheumatoid arthritis according to established criteria (indicated on the Special Authority form below) when a Special Authority request is submitted by a rheumatologist.

First approval: 1 year

Renewal: 1 year or indefinite

Practitioner exemptions

  • None

Special notes

  • None

Special Authority request forms