Rinvoq LQ — Medica
Other inflammatory conditions
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Otezla
- Skyrizi subcutaneous (pen or syringe)
- Stelara subcutaneous
- Taltz
- Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- AND has tried one of Enbrel or an adalimumab product (trial of Cimzia, infliximab product, or Simponi also counts)
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- AND for continuation, has tried one of Enbrel or an adalimumab product OR is established on Rinvoq/LQ ≥ 90 days with verification in claims or by prescriber
Approval duration
6 months for initial therapy; 1 year for continuation or as directed for other conditions