Arcalyst (rilonacept) — CareFirst (Caremark)
Deficiency of Interleukin-1 Receptor Antagonist (DIRA)
Preferred products
- Kineret (anakinra)
Initial criteria
- Member weighs ≥ 10 kg
- Member has IL1RN gene variants
- Arcalyst will be used for maintenance of remission following treatment with Kineret (anakinra)
- Member has had a documented negative tuberculosis (TB) test within 12 months of initiating therapy or treatment completed for latent TB as applicable
- Member will not use the requested medication concomitantly with any other biologic drug or targeted synthetic drug
- Prescribed by or in consultation with a rheumatologist or immunologist
Reauthorization criteria
- Member weighs ≥ 10 kg
- Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition
Approval duration
12 months