Orencia subcutaneous — Medica

Initial criteria

• Patient meets the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria
• AND meets ONE of the following: (a) patient has tried TWO of a tocilizumab subcutaneous product, Enbrel, an adalimumab product, Rinvoq/Rinvoq LQ, or Xeljanz [documentation required]; OR (b) patient has heart failure, a previously treated lymphoproliferative disorder, a previous serious infection, OR a demyelinating disorder

Approval duration

6 months