Xeljanz (tofacitinib) — Highmark
Ankylosing Spondylitis
Preferred products
- adalimumab product
- Enbrel
Initial criteria
- age ≥ 18 years
- diagnosis of ankylosing spondylitis
- prescribed by or in consultation with a rheumatologist
- experienced therapeutic failure or intolerance to a preferred adalimumab product or Enbrel for the treatment of ankylosing spondylitis
Reauthorization criteria
- member has demonstrated disease stability or a beneficial response to therapy
Approval duration
12 months