Olumiant — Medica
Other inflammatory conditions per Olumiant policy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Meets the standard Inflammatory Conditions – Olumiant Prior Authorization Policy criteria
- AND has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]
Reauthorization criteria
- Meets the standard Inflammatory Conditions – Olumiant Prior Authorization Policy criteria
- AND (has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq, and Xeljanz/XR [documentation required] OR has been established on Olumiant for ≥ 90 days with verification in prescription claims history or by prescriber if claims unavailable)
Approval duration
initial: 6 months; reauthorization: 1 year