Arcalyst (rilonacept subcutaneous injection) — Cigna

Initial criteria

• Patient is ≥ 10 kg (22 pounds); AND
• Genetic testing has confirmed bi-allelic pathogenic variants in the IL1RN gene; AND
• According to the prescriber, patient has demonstrated a clinical benefit with Kineret (anakinra subcutaneous injection); AND
• The medication is prescribed by or in consultation with a rheumatologist, geneticist, dermatologist, or a physician specializing in the treatment of autoinflammatory disorders

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