Orencia SC (abatacept) — Highmark
Enthesitis and/or dactylitis associated Psoriatic Arthritis
Preferred products
- Enbrel
- preferred ustekinumab SC product
- Cimzia
- Remicade
- Remicade biosimilars
- Simponi
- Simponi Aria
Initial criteria
- age ≥ 2 years
- diagnosis matches indication type (spinal/axial, non-axial, or enthesitis/dactylitis PsA)
- prescribed by or in consultation with a rheumatologist or dermatologist
- for spinal/axial PsA: therapeutic failure or intolerance to at least one NSAID, or all NSAIDs contraindicated
- for non-spinal/axial PsA: therapeutic failure or intolerance to at least one non-biologic DMARD (e.g., methotrexate, leflunomide, sulfasalazine, cyclosporine), or all non-biologic DMARDs contraindicated
- for enthesitis/dactylitis PsA: therapeutic failure or intolerance to at least one NSAID or local glucocorticoid injection, or all NSAIDs and local glucocorticoid injections contraindicated
- AND one of the following: (A) if age ≥18 years, therapeutic failure/intolerance to at least two step 1 or 2a preferred agents for PsA (see Table 1; note a trial of Cimzia, an infliximab product, or Simponi counts as TNFi trial); OR (B) if age <18 years, therapeutic failure/intolerance to one preferred agent (Enbrel or preferred ustekinumab SC product; note a trial of another TNFi counts for Enbrel); OR (C) member has heart failure, previously treated lymphoproliferative disorder, previous serious infection, or demyelinating disorder
Reauthorization criteria
- disease stability or beneficial response to therapy