Orencia Subcutaneous — Medica

Initial criteria

• Patient meets the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria
• Patient meets ONE of the following: a) Patient is age ≥ 18 years AND has tried TWO of Enbrel, an adalimumab product, Otezla, Rinvoq/Rinvoq LQ, Skyrizi subcutaneous, an ustekinumab subcutaneous product, Taltz, Tremfya subcutaneous, or Xeljanz/XR [documentation required]; OR b) Patient is < 18 years AND has tried ONE of Enbrel, Otezla, Rinvoq/Rinvoq LQ, or an ustekinumab subcutaneous product [documentation required]

Approval duration

6 months