Kevzara — Cigna

psoriatic arthritis

Preferred products

Enbrel
adalimumab-adbm
adalimumab-adaz
Simlandi (adalimumab-ryvk)
Taltz
Otezla
Skyrizi SC
Ustekinumab SC Products (Stelara SC, Imuldosa SC, Selarsdi SC, ustekinumab-ttwe SC, Yesintek SC)
Tremfya SC

Patient must meet the respective standard Prior Authorization Policy criteria for the requested inflammatory condition AND
Patient must have tried the Preferred Product(s) according to step level when clinically appropriate prior to approval of a Non-Preferred Product AND
Step 1 (Preferred Products): Enbrel, adalimumab products (Cyltezo/adalimumab-adbm, adalimumab-adaz, Simlandi/adalimumab-ryvk) ± Taltz, Otezla, Skyrizi SC, Ustekinumab SC Products (Stelara SC, Imuldosa SC, Selarsdi SC, ustekinumab-ttwe SC, Yesintek SC) ± Tremfya SC depending on indication
Step 2a (Non-Preferred directed to one Step 1 Product): Tocilizumab SC Products (Actemra SC, Tyenne SC) or Rinvoq (tablets, LQ) or Xeljanz (tablets, XR tablets, oral solution) depending on indication
Step 2b (Non-Preferred directed to one Step 1 Product): Bimzelx if applicable
Step 3a (Non-Preferred directed to two Step 1 or Step 2a Products with documentation required): Cimzia, Kevzara, Kineret, Olumiant, Orencia SC, Simponi SC, Cosentyx SC
Prescriber must provide written documentation supporting trials of required Preferred Products [documentation required] which may include chart notes, prescription claims, or receipts

Continuation of therapy with a Non-Preferred Product must be supported with verification in prescription claims history showing that the patient has received the product for 90 or 120 days within a 130-day look‑back period OR prescriber verification that the patient has been receiving the product for that period via paid claims (no samples/coupons)
Other continuation conditions may apply as specified in the step criteria

1 year