Kevzara — Medica
Other Inflammatory Conditions
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Rinvoq LQ
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria
Reauthorization criteria
- Patient meets BOTH of the following:
- i. Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria; AND
- ii. Patient meets ONE of the following:
- a) For Rheumatoid Arthritis: patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]; OR
- b) For Juvenile Idiopathic Arthritis: patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, Rinvoq LQ, or Xeljanz [documentation required]; OR
- c) According to prescriber, patient has heart failure or a previously treated lymphoproliferative disorder; OR
- d) Patient has been established on Kevzara for ≥90 days and prescription claims show ≥90‑day supply dispensed within past 130 days, or as verified by prescriber if claims unavailable
Approval duration
1 year