Orencia — CareFirst (Caremark)
moderately to severely active polyarticular or articular juvenile idiopathic arthritis (JIA)
Initial criteria
- Member age ≥2 years
- Authorization of 12 months may be granted if previously received a biologic or targeted synthetic drug indicated for JIA OR one of:
- — Inadequate response to methotrexate or another csDMARD (e.g., leflunomide, sulfasalazine, hydroxychloroquine) at adequate dose and duration
- — Inadequate response to scheduled NSAIDs and/or intra‑articular glucocorticoids (e.g., triamcinolone hexacetonide) and one of: involvement of ankle, wrist, hip, sacroiliac, or TMJ; erosive disease or enthesitis; delay in diagnosis; elevated inflammatory markers; symmetric disease
- — Member has risk factors for disease severity (Appendix B) and either: high‑risk joints (cervical spine, wrist, or hip) involved, high disease activity, or high risk for disabling joint disease
Reauthorization criteria
- Authorization of 12 months may be granted for members showing positive clinical response
Approval duration
12 months