Rinvoq LQ — Cigna
Juvenile Idiopathic Arthritis or Psoriatic Arthritis – Patient is Currently Receiving Rinvoq/LQ
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- 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 – Rinvoq/LQ Prior Authorization Policy criteria; AND
- Patient meets ONE of the following: (a) Juvenile Idiopathic Arthritis with trial of Enbrel or an adalimumab product (or Cimzia, an infliximab product, or Simponi Aria); OR (b) Psoriatic Arthritis with trial of Enbrel or an adalimumab product (or Cimzia, an infliximab product, or Simponi Aria or subcutaneous); OR (c) Patient has been established on Rinvoq/LQ ≥ 90 days and prescription claims history confirms supply within past 130 days or prescriber verification
Approval duration
1 year