anakinra — CareFirst (Caremark)

Moderately to severely active rheumatoid arthritis (RA)

Initial criteria

Age ≥ 18 years
Member meets either of the following biomarker criteria: (a) Positive for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP); OR (b) Tested for RF, anti-CCP, and C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)
Member meets ONE of the following regarding methotrexate (MTX) and conventional synthetic DMARDs:
1. Failed to achieve low disease activity after 3-month trial of MTX monotherapy (≥15 mg/week) and had inadequate response or intolerance to, or contraindication to hydroxychloroquine and/or sulfasalazine; and has moderate to high disease activity
2. Unable to tolerate 3-month trial of MTX monotherapy and had inadequate response or intolerance to, or contraindication to leflunomide, hydroxychloroquine, or sulfasalazine; and has moderate to high disease activity
3. Experienced intolerable adverse event or contraindication to MTX, discontinued MTX, and had inadequate response or intolerance to, or contraindication to leflunomide, hydroxychloroquine, or sulfasalazine; and has moderate to high disease activity

12 months