Olumiant (baricitinib tablets – Lilly) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has had a 3‑month trial of at least ONE tumor necrosis factor inhibitor OR tried but was unable to tolerate a 3‑month trial of a tumor necrosis factor inhibitor
• Medication prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient established on Olumiant for ≥ 6 months
• Patient experienced a beneficial clinical response when assessed by at least one objective measure (e.g., CDAI, DAS28, PAS‑II, RAPID‑3, SDAI) OR patient experienced improvement in at least one symptom such as decreased joint pain, morning stiffness, or fatigue; improved function or activities of daily living; decreased soft tissue swelling in joints or tendon sheaths

Approval duration

initial 6 months; reauth 1 year