upadacitinib — CareFirst (Caremark)

Initial criteria

• Member age ≥ 2 years with active polyarticular juvenile idiopathic arthritis
• 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) or targeted synthetic drug indicated for active pJIA

Reauthorization criteria

• Member age ≥ 2 years using the medication for pJIA and achieves or maintains positive clinical response (criteria similar to PsA though not explicitly restated)

Approval duration

12 months