Xeljanz XR — CareFirst (Caremark)
Immune checkpoint inhibitor-related toxicity (diarrhea or colitis)
Initial criteria
- Member has immune checkpoint inhibitor-related diarrhea or colitis
- Member has experienced an inadequate response, intolerance, or contraindication to infliximab or vedolizumab
Reauthorization criteria
- Member meets all requirements in the coverage criteria
Approval duration
6 months