Orencia Subcutaneous — Medica
Rheumatoid Arthritis – Initial Therapy
Preferred products
- Actemra subcutaneous
- Tyenne subcutaneous
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Rinvoq
- Xeljanz tablets
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Orencia Subcutaneous Prior Authorization Policy criteria
- Patient meets ONE of the following: a) Patient has tried TWO of tocilizumab subcutaneous, Enbrel, an adalimumab product, Rinvoq, or Xeljanz/XR [documentation required]; OR b) According to the prescriber, patient has heart failure, a previously treated lymphoproliferative disorder, a previous serious infection, OR a demyelinating disorder
Approval duration
6 months