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The Policy VaultThe Policy Vault

Arcalyst (rilonacept) — Medica

familial cold autoinflammatory syndrome (FCAS)

Preferred products

  • Ilaris (canakinumab)

Initial criteria

  • Patient meets the standard Prior Authorization Policy criteria for cryopyrin-associated periodic syndromes (CAPS) [documentation required]
  • Patient has tried one Preferred Product (Ilaris) prior to approval of a Non-Preferred Product OR meets exception criteria