Olumiant — Blue Cross Blue Shield of Alabama
based on step table disease states: RA, PsA, PS, AS, nr-axSpA, PJIA, SJIA, HS, CD, UC, GCA, SSc-ILD, Uveitis
Preferred products
- adalimumab product(s) (Adalimumab-aaty, Adalimumab-adaz, Hadlima, Humira, Simlandi)
- Cosentyx
- Enbrel
- Skyrizi
- Tremfya
- ustekinumab product(s) (Selarsdi, Steqeyma, Stelara, Yesintek)
- Otezla
- Rinvoq
- Rinvoq LQ
- Xeljanz
- Xeljanz XR
- Entyvio
- Sotyktu
Initial criteria
- If client has preferred agents, then must have failed preferred per disease-specific steps:
- • If nonpreferred selected, must have inadequate response/intolerance/contraindication to required number of Step 1 agents per step table (1–3 depending on disease)
- • Documentation of failed/contraindicated preferred agents required (≥6 months per agent unless specified)
- Meets all general conditions above under initial evaluation (specialist involvement, TB testing, no contraindication, etc.)
Reauthorization criteria
- Continued clinical benefit and stability per specialist documentation
- Ongoing compliance with general policy conditions
- Step therapy re-evaluation confirming failure or intolerance remains applicable
Approval duration
12 months