Arcalyst (rilonacept) — Medica

Initial criteria

• Patient weighs ≥ 10 kg (22 pounds)
• Genetic testing has confirmed bi-allelic pathogenic variants in the IL1RN gene
• According to the prescriber, patient has demonstrated a clinical benefit with Kineret (anakinra)
• Medication is prescribed by or in consultation with a rheumatologist, geneticist, dermatologist, or physician specializing in the treatment of autoinflammatory disorders

Reauthorization criteria

• Patient has been established on this medication for at least 6 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline OR compared with baseline, patient experienced an improvement in at least one symptom

Approval duration

initial: 6 months; renewal: 1 year