Rinvoq extended-release tablets — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has had a 3‑month trial of at least one tumor necrosis factor inhibitor OR was unable to tolerate a 3‑month trial of a tumor necrosis factor inhibitor
• Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response from baseline when assessed by at least one objective measure such as fecal markers, serum markers, endoscopic assessment, or reduced dose of corticosteroids OR experienced improvement in at least one symptom such as decreased pain, fatigue, stool frequency, or rectal bleeding

Approval duration

initial 6 months, reauth 1 year