Olumiant — Cigna
Rheumatoid Arthritis
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 – Olumiant Prior Authorization Policy criteria
- Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Olumiant Prior Authorization Policy criteria
- Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, and Xeljanz/XR [documentation required]; OR
- Patient has been established on Olumiant for ≥ 90 days AND prescription claims history indicates a ≥ 90-day supply dispensed within the past 130 days, or verified by prescriber if claims unavailable.
Approval duration
initial 6 months; reauthorization 1 year