Kevzara — Cigna
Rheumatoid Arthritis – Initial Therapy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria; AND
- Patient meets ONE of the following (a or b):
- a) Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]; OR
- b) According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder.
Approval duration
6 months