Orencia (abatacept intravenous infusion) — Cigna

Initial criteria

• Patient age ≥ 18 years; AND
• Patient has tried ONE conventional synthetic DMARD for at least 3 months; AND
• The medication is prescribed by or in consultation with a rheumatologist; OR
• An exception to DMARD trial applies if the patient has already had a 3-month trial of at least one biologic other than the requested drug (a biosimilar of the requested biologic does not count).

Reauthorization criteria

• Patient currently receiving Orencia (Intravenous or Subcutaneous); AND
• Patient has been established on therapy for at least 6 months; AND
• 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 an improvement in at least one symptom such as decreased joint pain, morning stiffness, fatigue, improved function, or decreased joint swelling.

Approval duration

1 year