Kevzara (sarilumab) — CareFirst (Caremark)

Initial criteria

• Member weight ≥63 kg
• Has previously received a biologic or targeted synthetic drug indicated for active pJIA OR meets the following:
• Inadequate response to methotrexate or other conventional synthetic drug (leflunomide, sulfasalazine, or hydroxychloroquine) at adequate dose and duration
• Inadequate response to trial of scheduled NSAIDs and/or intra-articular glucocorticoids and presence of one risk factor for poor outcome including involvement of ankle, wrist, hip, sacroiliac, or TMJ joint, erosive disease or enthesitis, delay in diagnosis, elevated inflammation markers, or symmetric disease
• Has risk factors for disease severity (per Appendix B) and either high-risk joint involvement (cervical spine, wrist, or hip), high disease activity, or high risk for disabling joint disease

Reauthorization criteria

• Positive clinical response as evidenced by low disease activity or improvement in signs/symptoms when there is improvement in any of the following: number of joints with active arthritis, joints with limitation of movement, or functional ability

Approval duration

12 months