Arcalyst (rilonacept) — Highmark
Deficiency of Interleukin-1 Receptor Antagonist (DIRA)
Initial criteria
- member weighs ≥ 10 kg
- diagnosis of DIRA requiring maintenance of remission
- prescribed by or in consultation with a rheumatologist, geneticist, dermatologist, or physician specializing in the treatment of autoinflammatory disorders
- genetic testing has confirmed a mutation in the IL1RN gene
- member has previously experienced clinical benefit from Kineret (anakinra) for induction treatment of DIRA
Reauthorization criteria
- member is tolerating therapy AND has experienced disease improvement OR delayed disease progression