Olumiant — CareFirst (Caremark)

Initial criteria

• age ≥ 18 years
• Member has experienced an inadequate response, intolerance, or has a contraindication to at least one tumor necrosis factor (TNF) inhibitor OR has previously received a biologic (other than a TNF inhibitor) or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for moderately to severely active rheumatoid arthritis
• Member has had a documented negative tuberculosis (TB) test within 12 months of initiating therapy if naïve to biologic or targeted synthetic drugs associated with increased TB risk
• If TB screening is positive, active disease must be ruled out (e.g., chest x-ray); members with active TB infection must not receive therapy; latent disease must be treated before initiation
• Medication is not used concomitantly with any other biologic drug, targeted synthetic drug, or potent immunosuppressant such as azathioprine or cyclosporine
• Prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Member achieves or maintains a positive clinical response evidenced by at least 20% improvement from baseline in tender joint count, swollen joint count, pain, or disability

Approval duration

12 months