Idacio (adalimumab-aacf) — CareFirst (Caremark)
Rheumatoid arthritis (RA)
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 moderately to severely active RA
- Member has been tested for either rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies and one test was positive, OR member has been tested for RF, anti-CCP, and C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)
- Member meets ONE of the following: failed to achieve low disease activity after a 3‑month trial of methotrexate (MTX) monotherapy at ≥15 mg/week and has inadequate response or intolerance to hydroxychloroquine and/or sulfasalazine, OR unable to tolerate MTX monotherapy but has failed or is intolerant to leflunomide, hydroxychloroquine, or sulfasalazine, OR has documented contraindications to these drugs, and member has moderate to high disease activity
Reauthorization criteria
- Chart notes or medical record documentation supporting positive clinical response
Approval duration
12 months