Xeljanz oral solution — Cigna
Juvenile Idiopathic Arthritis
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
Initial criteria
- Patient meets the standard Inflammatory Conditions – Xeljanz/XR Prior Authorization Policy criteria
- AND patient has tried ONE of Enbrel or an adalimumab product (Humira, Abrilada, adalimumab-adaz, adalimumab-adbm, adalimumab-fkjp, adalimumab-aaty, adalimumab-ryvk, Simlandi, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry); a trial of Cimzia, an infliximab product (Remicade or biosimilars), or Simponi Aria also counts
Approval duration
6 months