Arcalyst (rilonacept subcutaneous injection) — Cigna
Cryopyrin-Associated Periodic Syndromes (CAPS) including familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS), and/or neonatal onset multisystem inflammatory disease (NOMID) formerly known as chronic infantile neurological cutaneous and articular syndrome (CINCA)
Initial criteria
- Patient is age ≥ 12 years; AND
- The medication is prescribed by or in consultation with a rheumatologist, geneticist, allergist/immunologist, or dermatologist
Reauthorization criteria
- Patient has been established on this medication for at least 6 months; AND
- Patient meets at least ONE of the following: (a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (prior to initiating the requested drug); OR (b) Compared with baseline, patient experienced an improvement in at least one symptom
Approval duration
initial 6 months; reauth 1 year