Orencia subcutaneous — Cigna
Psoriatic Arthritis (age < 18 years)
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Rinvoq LQ
- Xeljanz tablets
- Xeljanz XR
- Otezla
- Skyrizi subcutaneous (pen or syringe)
- Stelara subcutaneous
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Taltz
- Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria
- For Rheumatoid Arthritis: patient has tried ONE of the following: a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq/Rinvoq LQ, or Xeljanz tablets or oral solution [documentation required]; OR
- For Psoriatic Arthritis (age ≥ 18 years): patient has tried TWO of Enbrel, an adalimumab product, Otezla, Rinvoq/Rinvoq LQ, Skyrizi subcutaneous, an ustekinumab subcutaneous product, Taltz, Tremfya subcutaneous, or Xeljanz/XR [documentation required]; OR
- For Psoriatic Arthritis (age < 18 years): patient has tried ONE of Enbrel, Otezla, Rinvoq/Rinvoq LQ, or an ustekinumab subcutaneous product [documentation required]; OR
- Patient is established on Orencia intravenous for ≥ 90 days; OR
- Patient has one of the following: heart failure, previously treated lymphoproliferative disorder, previous serious infection, or demyelinating disorder; OR
- Patient has been established on Orencia subcutaneous for ≥ 90 days AND prescription claims history indicates ≥ 90-day supply dispensed within past 130 days (or verified by prescriber if claims unavailable).
Reauthorization criteria
- Patient continues to meet the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria.
Approval duration
initial duration as directed or 1 year for continuing therapy