Cosentyx access guide: secukinumab multi-indication coverage, IV vs SC benefit routing, payer step edits, and support

Cosentyx (secukinumab, Novartis) is a fully human interleukin-17A antagonist approved for six immune-mediated diseases: plaque psoriasis (PsO), psoriatic arthritis (PsA), ankylosing spondylitis (AS), non-radiographic axial spondyloarthritis (nr-axSpA), enthesitis-related arthritis (ERA), and hidradenitis suppurativa (HS). Since its 2015 launch, Cosentyx has been used by more than 1.8 million patients worldwide. In March 2026, the FDA expanded the HS indication to include pediatric patients 12 years and older, making Cosentyx the only IL-17A inhibitor approved for pediatric HS.

The drug's breadth across dermatology and rheumatology creates distinct payer step-therapy pathways, IV vs SC benefit-routing complications, and indication-specific PA documentation requirements that access teams must navigate.

This guide covers formulary positioning, step-therapy hierarchies, benefit-channel routing, and patient support for secukinumab across all six indications.

Short answer

Indication-specific coverage criteria

Plaque psoriasis (PsO)

Plaque psoriasis is the most common indication for Cosentyx and has the most developed step-therapy requirements. Across UHC, Cigna, Mass General Brigham, and FEP Blue, the typical PA pathway requires:

1. Diagnosis: moderate-to-severe plaque psoriasis confirmed by a dermatologist (or rheumatologist for PsA overlap)
2. Body surface area: at least 3% BSA affected, OR crucial body areas involved (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas)
3. Topical therapy failure: minimum 4-week trial and failure of at least one topical agent — corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, or coal tar. Severe disease may warrant biologic-first without topical trial.
4. Systemic therapy trial: failure, intolerance, or contraindication to either conventional systemic therapy (methotrexate, cyclosporine, acitretin) or phototherapy. Cigna added an exception: a 3-month trial of Otezla/Otezla XR (apremilast) or Sotyktu (deucravacitinib) can substitute for a traditional systemic agent.
5. Biologic step edits: many plans require trial and failure of preferred biologics before Cosentyx. Mass General Brigham requires failure of two of the following: Cimzia, Enbrel, preferred adalimumab products (Humira, Hadlima, Simlandi, Yuflyma), Otezla/Otezla XR, Skyrizi, Sotyktu, preferred ustekinumab products (Selarsdi, Steqeyma, Yesintek), or Tremfya — and then failure of both Taltz and Bimzelx before Cosentyx.

Psoriatic arthritis (PsA)

PsA coverage criteria are slightly less restrictive:

1. Diagnosis: active PsA confirmed by a rheumatologist, age 2+
2. DMARD failure: trial and failure of methotrexate at maximally indicated dose (unless contraindicated), OR prior treatment with a systemic targeted immunomodulator for PsA
3. Biologic step therapy: UHC requires failure of at least one preferred biologic (adalimumab, Cimzia, Enbrel, Skyrizi, Sotyktu, preferred ustekinumab, Tremfya) before Cosentyx for PsA. Plans may also require prior TNF-inhibitor experience.

Ankylosing spondylitis (AS) and nr-axSpA

AS and nr-axSpA share a common step-therapy structure:

1. Diagnosis: active AS or nr-axSpA with objective signs of inflammation (elevated CRP and/or MRI evidence of sacroiliitis)
2. NSAID failure: inadequate response or intolerance to at least two NSAIDs over a minimum of 4 weeks total
3. Biologic positioning: TNF inhibitors or IL-17 inhibitors are recommended as initial biologic therapy per ACR guidelines. Some plans require TNF-inhibitor failure before an IL-17 inhibitor like Cosentyx.

Cigna updated its age requirement for AS initial therapy from 18+ to 12+ effective March 18, 2026.

Hidradenitis suppurativa (HS)

HS is the newest Cosentyx indication and has specific PA requirements:

1. Diagnosis: moderate-to-severe HS (Hurley Stage II or III), confirmed by a dermatologist
2. Antibiotic trial: failure of at least one oral antibiotic (doxycycline, clindamycin, or rifampin) at maximally indicated doses — unless contraindicated
3. Biologic sequencing: UHC requires that for HS, Cosentyx is not used in combination with other targeted immunomodulators including adalimumab, Bimzelx, Cimzia, Enbrel, Orencia, Otezla, Rinvoq, Simponi, Skyrizi, Taltz, Tremfya, Xeljanz, or ustekinumab
4. Pediatric HS (age 12+): the March 2026 FDA approval for pediatric HS expanded coverage to patients 12 years and older. Cigna updated its HS criteria to age 12+ effective the same month.

Enthesitis-related arthritis (ERA)

ERA coverage applies to pediatric patients age 4+:

1. Diagnosis: active ERA confirmed by a pediatric rheumatologist
2. NSAID trial: failure or intolerance of at least one NSAID
3. Biologic positioning: step-therapy requirements vary by plan; some require DMARD trial first

IV vs SC benefit routing

Cosentyx is unique among IL-17 inhibitors in offering both IV and SC formulations, and the benefit-channel split creates operational complexity:

Pharmacy benefit (SC)

Cosentyx SC (prefilled syringe and autoinjector) is dispensed through specialty pharmacies on the pharmacy benefit. Most plans designate it as specialty-only, requiring a contracted specialty pharmacy.

Mass General Brigham Health Plan explicitly states: "Cosentyx subcutaneous Prefilled Syringe and Auto-Injector are available via Pharmacy Benefit Only."

Medical benefit (IV)

Cosentyx IV is administered in clinical settings and billed under the medical benefit. UHC's Commercial Medical Benefit Drug Policy (effective June 1, 2026) covers Cosentyx IV with diagnosis-specific criteria and uses applicable HCPCS codes (J3590 or plan-specific codes).

Routing implications

When a patient transitions from SC to IV (or vice versa), a new PA is typically required because the benefit channel changes. Access teams should:

• Confirm the prescribed formulation matches the benefit channel the plan expects
• File a new PA when switching between SC and IV
• Verify that the specialty pharmacy can dispense the correct formulation

2026 PBM formulary positioning

Express Scripts National Preferred Formulary

Cosentyx is not listed as a preferred product on the Express Scripts 2026 National Preferred Formulary for inflammatory conditions. Preferred IL-17 agents include Taltz. Cosentyx requires step-therapy failure of preferred alternatives before coverage.

UHC / Optum Rx

Cosentyx SC is subject to prior authorization and step therapy on UHC commercial plans. The step-therapy program requires trial of preferred products (preferred adalimumab products, Cimzia, Cosentyx itself is sometimes listed as a step agent for other drugs, Enbrel, Skyrizi, Sotyktu, preferred ustekinumab products, Tremfya) before non-preferred agents.

FEP Blue

FEP Blue covers Cosentyx as a specialty medication requiring PA. For plaque psoriasis, patients must have tried preferred products per Appendix 2 of the formulary policy unless a valid medical exception exists. Step therapy is required for patients 18+ for PsA when adjudicated through the pharmacy benefit.

Cosentyx Connect and patient support

Co-Pay Plus Program

• Commercially insured patients may pay as little as $0 per month with the Co-Pay Plus card
• Annual co-pay benefit limit applies; not valid under Medicare, Medicaid, or federal/state programs
• Novartis reserves the right to rescind or amend the program without notice

Covered Until You're Covered bridge program

For patients whose private insurance denies coverage:

• Provides free Cosentyx SC for up to 2 years or until insurance coverage approval, whichever comes first
• Patient must have private insurance and a valid prescription
• An appeal of the coverage denial must be submitted within the first 90 days of enrollment
• Not available for Medicare, Medicaid, TRICARE, or other government programs

IV Start Form and SC Start Form

Novartis provides separate start forms for SC and IV formulations. The HCP website (cosentyxhcp.com) includes:

• Local insurance coverage tool showing formulary positioning by plan
• SC Start Form for pharmacy benefit routing
• IV Start Form for medical benefit routing
• Co-Pay Plus Portal for commercial patients
• Sample request line: 866-318-6977

Direct-to-patient option

For patients without insurance or who choose to pay out of pocket, Novartis offers a direct-to-patient pricing option for Cosentyx SC:

• Cosentyx Sensoready Pen (150 mg): $3,434 (55% discount off list price)
• Cosentyx UnoReady Pen (300 mg): $3,434 (57% discount off list price)
• Cosentyx Prefilled Syringe (150 mg): $3,434 (55% discount off list price)
• Cosentyx Prefilled Syringe (75 mg): $1,717 (55% discount off list price)

This option is available through Novartis Patient Support.

Contact

• Novartis Patient Support: 1-844-COSENTYX (1-844-267-3689)
• Start forms and coverage tool: cosentyxhcp.com
• Cost and co-pay information: cosentyx.com/treatment-cost

Reauthorization documentation

Across major payers, Cosentyx reauthorization every 12 months requires:

1. Documentation of positive clinical response: evidenced by low disease activity or improvement in signs and symptoms
   • PsO: reduction in BSA from baseline, improvement in PASI score
   • PsA: improvement in joint counts, inflammatory markers, or functional status
   • AS/nr-axSpA: improvement in BASDAI score, CRP, or functional measures
   • HS: reduction in abscesses, inflammatory nodules, or draining fistulae
2. No concurrent targeted immunomodulators: Cosentyx must not be combined with other biologic DMARDs or targeted synthetic DMARDs for the same indication
3. Prescriber attestation: confirm monitoring for onset or exacerbation of Crohn's disease or ulcerative colitis (a known risk of IL-17 inhibitors) and agree to discontinue if IBD develops

Documentation checklist for PA submission

1. ICD-10 codes: L40.0 (plaque psoriasis), L40.50–L40.59 (psoriatic arthropathy), M45.x (ankylosing spondylitis), L73.2 (hidradenitis suppurativa), M08.x (ERA/juvenile arthritis)
2. Disease severity: BSA percentage, PASI score, Hurley stage (HS), BASDAI score (AS), joint counts (PsA), MRI findings (nr-axSpA)
3. Prior treatment history: drug name, dose, start/stop dates, and reason for discontinuation for each prior therapy
4. TB screening: negative TB test (TST or IGRA) within 12 months of initiation for biologic-naive patients
5. Specialist attestation: prescribed by or in consultation with a dermatologist (PsO, HS) or rheumatologist (PsA, AS, nr-axSpA, ERA)
6. Formulary exception letter (if non-preferred): document why preferred alternatives are not appropriate, citing contraindications, prior failures, or disease-specific considerations

Key takeaways for access teams

• Cosentyx spans six indications with distinct step-therapy pathways: verify the specific indication and plan-specific PA criteria before filing.
• IV routes through medical benefit; SC through pharmacy benefit: confirm the correct channel to avoid PA rework.
• PsO step therapy is the most demanding: many plans require failure of multiple biologics (including both Taltz and Bimzelx) before Cosentyx for psoriasis.
• Pediatric HS (age 12+) is newly approved as of March 2026: update PA templates to reflect the expanded age range.
• The Covered Until You're Covered bridge provides up to 2 years of free drug during insurance appeals — a key option for patients facing initial denials.

Sources

• Novartis. Cosentyx (secukinumab) Prescribing Information. cosentyxhcp.com
• Novartis. FDA Approval of Cosentyx for Pediatric HS (age 12+). Press release, March 13, 2026. novartis.com/news/media-releases
• FDA. Cosentyx (secukinumab) Prescribing Information. BLA 125504. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/125504s026lbl.pdf
• FDA. Drugs@FDA: Cosentyx (secukinumab). https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
• UnitedHealthcare. Cosentyx (secukinumab) Prior Authorization/Medical Necessity. Program 2025 P 2196-16. Effective 01/17/2026. uhcprovider.com
• UnitedHealthcare. Cosentyx (Secukinumab) Commercial Medical Benefit Drug Policy. Policy 2026D0132E. Effective 06/01/2026. uhcprovider.com
• Cigna. Inflammatory Conditions – Cosentyx Subcutaneous Prior Authorization Policy. IP0678. Effective 01/01/2026. static.cigna.com
• Cigna. Cosentyx Subcutaneous Prior Authorization Policy (CNF). CNF_432. Selected revisions 03/18/2026, 04/29/2026. static.cigna.com
• Mass General Brigham Health Plan. Cosentyx (secukinumab) SC PA Policy. Effective 05/01/2026. resources.massgeneralbrighamhealthplan.org
• FEP Blue. Cosentyx (secukinumab) Coverage Policy. 5.90.011. Effective January 1, 2026. fepblue.org
• Aetna. Secukinumab (Cosentyx) Clinical Policy Bulletin. CPB 0905. aetna.com/cpb/medical/data/900_999/0905.html
• Aetna Better Health (Illinois). Cosentyx Coverage Policy/Guideline. Effective 06/20/2025. aetnabetterhealth.com
• Express Scripts. 2026 National Preferred Formulary. express-scripts.com/pdf/formulary/NPE1702_204612.pdf
• Novartis. Cosentyx Cost and Co-Pay Support. cosentyx.com/treatment-cost
• CounterForce Health. How to Get Cosentyx Covered by Cigna: Complete 2026 Guide. counterforcehealth.org