Rinvoq — Cigna
Non-Radiographic Spondyloarthritis (nr-axSpA)
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Taltz
- Omvoh subcutaneous
- Skyrizi subcutaneous (on-body injector)
- Stelara subcutaneous
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Tremfya subcutaneous
- Zymfentra
- Cimzia
Initial criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria; AND
- Patient meets one of the following:
- - Trial of Enbrel or adalimumab product if Ankylosing Spondylitis; OR
- - Trial of an adalimumab product if Crohn’s Disease; OR
- - Trial of Enbrel or adalimumab product if Juvenile Idiopathic Arthritis; OR
- - Trial of Cimzia if nr-axSpA; OR
- - Trial of Enbrel or adalimumab product if Rheumatoid Arthritis; OR
- - Trial of Enbrel or adalimumab product if Psoriatic Arthritis; OR
- - Trial of an adalimumab product if Ulcerative Colitis; OR
- - Patient established on Rinvoq ≥ 90 days verified via claims or prescriber statement.
Approval duration
1 year