Orencia (subcutaneous) — Cigna
Juvenile Idiopathic Arthritis/Juvenile Rheumatoid Arthritis – initial therapy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Rinvoq LQ
- Xeljanz tablets
- Xeljanz oral solution
Initial criteria
- Patient meets the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria; AND
- Patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq/Rinvoq LQ, or Xeljanz [documentation required]; OR
- According to the prescriber, the patient has heart failure, a previously treated lymphoproliferative disorder, a previous serious infection, OR a demyelinating disorder
Approval duration
6 months