upadacitinib — CareFirst (Caremark)

Initial criteria

• Adult member with moderately to severely active rheumatoid arthritis
• Member has experienced an inadequate response, intolerance, or has a contraindication to at least one tumor necrosis factor (TNF) inhibitor OR has previously received a biologic (other than a TNF inhibitor) or targeted synthetic drug (e.g., Xeljanz, Olumiant) indicated for moderately to severely active RA

Reauthorization criteria

• Adult member using the medication for moderately to severely active RA who achieves or maintains a positive clinical response as evidenced by disease activity improvement of at least 20% from baseline in tender joint count, swollen joint count, pain, or disability

Approval duration

12 months