Kevzara — Medica
Rheumatoid Arthritis
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Rinvoq LQ
- Xeljanz tablets
- Xeljanz XR
- Xeljanz oral solution
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria
- For Rheumatoid Arthritis: patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, and Xeljanz/XR [documentation required] OR
- For Juvenile Idiopathic Arthritis: patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq/Rinvoq LQ, and Xeljanz tablets or oral solution [documentation required] OR
- According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder OR patient has been established on Kevzara for at least 90 days with verification of recent prescription claims or prescriber verification
Approval duration
1 year