Rinvoq extended-release tablets — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Patient meets ONE of the following: (a) Patient has had a 3-month trial of at least one tumor necrosis factor inhibitor; OR (b) Patient has tried at least one tumor necrosis factor inhibitor but was unable to tolerate a 3-month trial
• The medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient meets 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 an improvement in at least one symptom such as decreased pain, fatigue, stool frequency, and/or blood in stool

Approval duration

initial: 6 months; reauth: 1 year