Skip to content
The Policy VaultThe Policy Vault

Rinvoq extended-release tabletsMedica

Ulcerative Colitis

Initial criteria

  • age ≥ 18 years
  • Patient has had a 3-month trial of at least one tumor necrosis factor inhibitor OR patient has tried at least one tumor necrosis factor inhibitor but was unable to tolerate a 3-month trial
  • Medication is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

  • Patient has been established on therapy for at least 6 months
  • When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline OR compared with baseline patient experienced an improvement in at least one symptom (e.g., decreased pain, fatigue, stool frequency, and/or rectal bleeding)

Approval duration

Initial: 6 months; Reauth: 1 year