upadacitinib — CareFirst (Caremark)

Initial criteria

• Member age ≥ 2 years with active psoriatic 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 (e.g., Xeljanz, Otezla) indicated for active psoriatic arthritis

Reauthorization criteria

• Member age ≥ 2 years using the medication for psoriatic arthritis and who achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition with improvement in any of the following from baseline: number of swollen joints, number of tender joints, dactylitis, enthesitis, axial disease, skin/nail involvement, functional status, or CRP

Approval duration

12 months