Idacio (adalimumab-aacf) — CareFirst (Caremark)
Polyarticular juvenile idiopathic arthritis (JIA)
Preferred products
- Abrilada
- Amjevita
- Cyltezo
- Hadlima
- Hulio
- Hyrimoz
- Simlandi
- Yuflyma
- Yusimry
- adalimumab (unbranded Humira)
- adalimumab-aacf (unbranded Idacio)
- adalimumab-aaty (unbranded Yuflyma)
- adalimumab-adaz (unbranded Hyrimoz)
- adalimumab-adbm (unbranded Cyltezo)
- adalimumab-bwwd (unbranded Hadlima)
- adalimumab-fkjp (unbranded Hulio)
- adalimumab-ryvk (unbranded Simlandi)
Initial criteria
- Member age ≥ 2 years
- Diagnosis of moderately to severely active polyarticular JIA
- Any of the following: inadequate response to methotrexate or another conventional synthetic drug (leflunomide, sulfasalazine, hydroxychloroquine); inadequate response to scheduled NSAIDs and/or intra-articular glucocorticoids with at least one poor outcome risk factor (involvement of ankle/wrist/hip/sacroiliac/TMJ joint, erosive disease or enthesitis, delayed diagnosis, elevated inflammation markers, symmetric disease); or member has high-risk joints involved (cervical spine, wrist, hip), high disease activity, or is judged at high risk for disabling joint disease
Reauthorization criteria
- Chart notes or medical record documentation supporting positive clinical response
Approval duration
12 months