Kevzara — Medica
ulcerative colitis
Preferred products
- adalimumab products (Cyltezo, adalimumab-adbm, adalimumab-adaz, Simlandi/adalimumab-ryvk)
- Enbrel
- Cosentyx SC
- Otezla
- Skyrizi SC
- Sotyktu
- Stelara SC
- Taltz
- Tremfya SC
- Omvoh SC
- Zymfentra
- Velsipity
Initial criteria
- Patient meets the respective standard Prior Authorization Policy criteria for the condition
- Trial and failure, contraindication, or intolerance to TWO Step 1 or Step 2a Preferred Products appropriate for the indication [documentation required]
- Non-Preferred Product request must be directed to indicated Step 1 therapy (e.g., adalimumab) when specified in table
Reauthorization criteria
- Patient is continuing therapy with a Non-Preferred Product and verification of prior use for 90 to 120 days within a 130-day look-back period is confirmed via claims or prescriber verification
- Continuation otherwise meets standard Prior Authorization Policy criteria
Approval duration
1 year