Orencia — CareFirst (Caremark)

Initial criteria

• Member age ≥ 2 years
• Requested medication is used for psoriatic arthritis
• Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition when there is improvement in any of the following from baseline: number of swollen joints, number of tender joints, dactylitis, enthesitis, skin and/or nail involvement, functional status, or C-reactive protein (CRP)
• Member has documented negative tuberculosis (TB) test (TST or IGRA) within 6 months of initiating therapy for biologic-naive members
• If TB test positive, further testing confirms no active disease; latent TB must be treated before initiation
• Requested medication not used concomitantly with other biologic drugs or targeted synthetic drugs for the same indication

Reauthorization criteria

• Member continues to achieve or maintain a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of psoriatic arthritis

Approval duration

12 months