Kevzara — Cigna
Juvenile Idiopathic Arthritis or Rheumatoid Arthritis – Patient is Currently Receiving Kevzara
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria; AND
- Patient meets ONE of the following (a–d):
- a) Patient has Rheumatoid Arthritis and has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]; OR
- b) Patient has Juvenile Idiopathic Arthritis and has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, Rinvoq LQ, or Xeljanz [documentation required]; OR
- c) According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder; OR
- d) Patient has been established on Kevzara for at least 90 days and prescription claims history indicates at least a 90-day supply of Kevzara was dispensed within the past 130 days, or if claims history not available, verified by prescriber.
Approval duration
1 year