Kevzara — Medica
Rheumatoid Arthritis – Initial Therapy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Kevzara Prior Authorization Policy criteria
- Patient has tried TWO of the following: a tocilizumab subcutaneous product (Actemra SC, Tyenne SC), Enbrel, an adalimumab product (Humira, Abrilada, adalimumab-adaz, adalimumab-adbm, adalimumab-fkjp, adalimumab-aaty, adalimumab-ryvk, Simlandi, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry), Rinvoq, or Xeljanz/Xeljanz XR [documentation required]; OR According to prescriber, patient has heart failure or previously treated lymphoproliferative disorder
Approval duration
6 months