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Arcalyst (rilonacept)Highmark

Recurrent Pericarditis (RP)

Initial criteria

  • age ≥ 12 years
  • diagnosis of recurrent pericarditis
  • prescribed by or in consultation with a cardiologist or rheumatologist
  • experienced at least one episode of acute pericarditis in past 365 days
  • experienced therapeutic failure or intolerance to ≥1 of: NSAIDs, systemic corticosteroids, OR colchicine tablets (or contraindication to all)

Reauthorization criteria

  • member is tolerating therapy AND has experienced disease improvement OR delayed disease progression