Humira (adalimumab) — Blue Cross Blue Shield of Kansas
FDA labeled indication or an indication supported in compendia for the requested agent and route of administration
Preferred products
- Adalimumab-aaty
- Adalimumab-adaz
- Hadlima (adalimumab-bwwd)
- Simlandi (adalimumab-ryvk)
Initial criteria
- ONE of the following must be met:
- A. The requested agent is eligible for continuation of therapy AND ONE of the following:
- • Patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days OR
- • Prescriber states patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed
- Agents Eligible for Continuation of Therapy: all target agents EXCEPT Abrilada, Adalimumab-ryvk, Amjevita, Cyltezo (adalimumab-adbm), Hulio (adalimumab-fkjp), Humira, Hyrimoz, Idacio (adalimumab-aacf), Yuflyma, Yusimry
- OR
- B. ALL of the following:
- 1. Patient has an FDA labeled indication or compendia-supported indication for the requested agent and route of administration AND ONE of the following:
- A. Moderately to severely active rheumatoid arthritis (RA) AND ONE of the following:
- • Tried and had an inadequate response to maximally tolerated methotrexate (e.g., titrated to 25 mg weekly) after at least a 3-month duration of therapy OR
- • Tried and had an inadequate response to ONE conventional agent (hydroxychloroquine, leflunomide, sulfasalazine)