Idacio (adalimumab-aacf) — CareFirst (Caremark)
Psoriatic arthritis (PsA)
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
- Adult member with active psoriatic arthritis
- Member has previously received or failed a biologic or targeted synthetic drug indicated for PsA, or meets criteria for inadequate response or intolerance to other systemic agents per policy
Reauthorization criteria
- Chart notes or medical record documentation supporting positive clinical response
Approval duration
12 months