Olumiant — Blue Cross Blue Shield of Oklahoma

Initial criteria

• The request is NOT for use of Olumiant or Actemra in the treatment of COVID-19 in hospitalized adults requiring oxygen, mechanical ventilation, or ECMO.
• If agent is eligible for continuation of therapy and patient treated within past 90 days and at risk if therapy changed OR
• The patient has an FDA labeled or compendia-supported indication for the requested agent AND, for rheumatoid arthritis: patient failed, had inadequate response to, or intolerance/contraindication to methotrexate or another conventional DMARD, or previously used another biologic for RA; for Simponi, must use with methotrexate unless intolerance or contraindication.