Rinvoq extended-release tablets — Cigna

Initial criteria

• Patient is age ≥ 12 years
• Patient meets ONE of the following: (a) Patient has had a 4-month trial of at least ONE systemic therapy; OR (b) Patient has tried at least ONE systemic therapy but was unable to tolerate a 4-month trial
• The medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist

Reauthorization criteria

• Patient has been established on therapy for at least 90 days
• Patient experienced a beneficial clinical response, defined as improvement from baseline in at least one of the following: estimated body surface area affected, erythema, induration/papulation/edema, excoriations, lichenification, and/or a decreased requirement for other topical or systemic therapies for atopic dermatitis
• Compared with baseline, patient experienced an improvement in at least one symptom, such as decreased itching

Approval duration

initial: 3 months; reauth: 1 year