Ilumya — Medica
Other Conditions
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Otezla
- Skyrizi subcutaneous (pen or syringe)
- Sotyktu
- Stelara subcutaneous
- Taltz
- Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Ilumya Prior Authorization Policy criteria
- Patient has tried TWO of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, Stelara subcutaneous, Taltz, or Tremfya subcutaneous [documentation required]
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Ilumya Prior Authorization Policy criteria
- Patient has tried TWO of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, Stelara subcutaneous, Taltz, or Tremfya subcutaneous; OR patient has been established on Ilumya for at least 90 days with prescription claims history verification or prescriber verification
Approval duration
3 months initial, 1 year reauthorization