upadacitinib — CareFirst (Caremark)

Initial criteria

• Adult member with moderately to severely active Crohn’s disease
• Member has had an inadequate response or intolerance to at least one TNF inhibitor OR has previously received a biologic (other than a TNF inhibitor) indicated for moderately to severely active Crohn’s disease

Reauthorization criteria

• Member using the medication for moderately to severely active Crohn’s disease and achieves or maintains positive clinical response (not explicitly defined)

Approval duration

12 months