Orencia (abatacept intravenous infusion) — Cigna

Initial criteria

• Patient age > 2 years; AND
• Patient meets ONE of the following: (a) tried one other agent for this condition (e.g., methotrexate, sulfasalazine, leflunomide, NSAID, or a biologic other than requested drug); OR (b) will be starting therapy concurrently with methotrexate, sulfasalazine, or leflunomide; OR (c) has an absolute contraindication to methotrexate, sulfasalazine, or leflunomide; OR (d) has aggressive disease as determined by the prescriber; AND
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months; AND
• Patient meets at least ONE of the following: (a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline; OR (b) Compared with baseline, patient experienced improvement in at least one symptom (e.g., limitation of motion, joint pain or tenderness, duration of morning stiffness, fatigue, function or activities of daily living)

Approval duration

initial 6 months, reauthorization 1 year