Kevzara (sarilumab) — CareFirst (Caremark)

Rheumatoid arthritis (RA)

Initial criteria

Adult members with moderately to severely active RA
Has previously received a biologic or targeted synthetic drug indicated for RA within the past 120 days OR meets the following:
Member tested positive for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP), OR has been tested for RF, anti-CCP, and C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)
AND one of the following:
Failed to achieve low disease activity after a 3‑month trial of methotrexate (MTX) monotherapy at a dose ≥15 mg/week and has inadequate response to or intolerance/contraindication to hydroxychloroquine and/or sulfasalazine, OR moderate to high disease activity
Unable to tolerate 3‑month trial of MTX (≥15 mg/week) and has inadequate response to or intolerance/contraindication to leflunomide, hydroxychloroquine, or sulfasalazine, OR moderate to high disease activity
Experienced intolerable adverse event or contraindication to MTX and has inadequate response to or intolerance/contraindication to leflunomide, hydroxychloroquine, or sulfasalazine, OR moderate to high disease activity

Positive clinical response as evidenced by ≥20% improvement from baseline in tender joint count, swollen joint count, pain, or disability

12 months