upadacitinib — CareFirst (Caremark)

Initial criteria

• Adult member with moderately to severely active ulcerative colitis
• 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) indicated for moderately to severely active UC

Reauthorization criteria

• Member using the medication for moderately to severely active ulcerative colitis and who achieves or maintains remission OR positive clinical response as evidenced by low disease activity or improvement in signs/symptoms (e.g., stool frequency, rectal bleeding, urgency, CRP, fecal calprotectin, mucosal appearance on endoscopy/CTE/MRE/ultrasound, or improved UCEIS or Mayo score)

Approval duration

12 months