adalimumab (preferred products) — Highmark
Polyarticular Juvenile Idiopathic Arthritis (PJIA)
Initial criteria
- age ≥ 2 years
- diagnosis of moderate to severe PJIA
- prescribed by or in consultation with a rheumatologist
- EITHER experienced therapeutic failure or intolerance to at least one non-biologic DMARD (for example, methotrexate, leflunomide, sulfasalazine, cyclosporine) OR all non-biologic DMARDs are contraindicated OR requires initial biologic therapy due to involvement of high‑risk joints (for example, cervical spine, wrist, or hip), high disease activity, and/or at high risk of disabling joint damage
Reauthorization criteria
- member has demonstrated disease stability or a beneficial response to therapy