Yuflyma — Blue Cross Blue Shield of Alabama
non-infectious intermediate uveitis, posterior uveitis, or panuveitis
Preferred products
- Adalimumab-aaty
- Adalimumab-adaz
- Hadlima (adalimumab-bwwd)
- Simlandi (adalimumab-ryvk)
- Abrilada (adalimumab-afzb)
- Adalimumab-aacf
- Adalimumab-adbm
- Adalimumab-fkjp
- Adalimumab-ryvk
- Amjevita (adalimumab-atto)
- Cyltezo (adalimumab-adbm)
- Hulio (adalimumab-fkjp)
- Humira (adalimumab)
- Hyrimoz (adalimumab-adaz)
- Idacio (adalimumab-aacf)
- Yuflyma (adalimumab-aaty)
- Yusimry (adalimumab-aqvh)
Initial criteria
- Requested agent eligible for continuation of therapy AND patient treated with requested agent within past 90 days OR prescriber states patient treated within past 90 days and at risk if therapy is changed
- Otherwise: patient has an FDA labeled indication or compendia-supported indication AND criteria specific to diagnosis
- For RA: tried and inadequate response to methotrexate ≥3 months OR tried and inadequate response to one conventional agent (hydroxychloroquine, leflunomide, sulfasalazine) ≥3 months OR intolerance/hypersensitivity/contraindication to conventional agent(s) OR prior use of biologic immunomodulator for RA
- For PsA: tried and inadequate response to one conventional agent (cyclosporine, leflunomide, methotrexate, sulfasalazine) ≥3 months OR intolerance/hypersensitivity/contraindication to conventional agent(s) OR severe active PsA OR concomitant severe psoriasis OR prior biologic immunomodulator or Otezla use for PsA
- For PS: tried and inadequate response to one conventional agent (acitretin, anthralin, calcipotriene, calcitriol, coal tar products, cyclosporine, methotrexate, pimecrolimus, PUVA, tacrolimus, tazarotene, topical corticosteroids) ≥3 months OR intolerance/hypersensitivity/contraindication to conventional agent(s) OR severe active PS OR concomitant severe PsA OR prior biologic immunomodulator or Otezla use for PS
- For CD: tried and inadequate response to one conventional agent (6-mercaptopurine, azathioprine, corticosteroids, methotrexate) ≥3 months OR intolerance/hypersensitivity/contraindication to conventional agent(s) OR prior biologic immunomodulator use for CD
- For UC: tried and inadequate response to one conventional agent (6-mercaptopurine, azathioprine, balsalazide, corticosteroids, cyclosporine, mesalamine, sulfasalazine) ≥3 months OR intolerance/hypersensitivity/contraindication to conventional agent(s) OR severely active ulcerative colitis OR prior biologic immunomodulator use for UC
- For non-infectious uveitis: inadequate response or intolerance/contraindication to one oral or periocular/intravitreal corticosteroid after ≥2 weeks AND inadequate response/intolerance/contraindication to one systemic agent (azathioprine, mycophenolate, methotrexate, cyclosporine, tacrolimus) after ≥3 months OR prior biologic immunomodulator use for uveitis
- For AS: inadequate response to two NSAIDs after ≥4 weeks total OR inadequate response to one NSAID after ≥4 weeks plus intolerance/hypersensitivity to another OR intolerance/hypersensitivity/contraindication to two NSAIDs OR prior biologic immunomodulator use for AS