Kineret — CareFirst (Caremark)

Initial criteria

• Member has an urticarial rash, monoclonal IgM (or IgG) gammopathy, and at least two of the following: fever, joint pain or inflammation, bone pain, lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, elevated erythrocyte sedimentation rate (ESR), or abnormalities on bone morphological study (e.g., increased bone density).
• Other possible causes of the signs and symptoms have been ruled out, including but not limited to hyperimmunoglobulin D syndrome, adult-onset Still’s disease, hypocomplementemic urticarial vasculitis, acquired C1 inhibitor deficiency, and cryoglobulinemia.

Approval duration

12 months