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Rinvoq — Medica

Non-Radiographic Spondyloarthritis (nr-axSpA)

Preferred products

  • Cimzia
  • Taltz

Initial criteria

  • Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
  • Patient has tried Cimzia (or Enbrel, adalimumab, infliximab, or Simponi counts)

Reauthorization criteria

  • Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
  • Patient continues to have nr-axSpA and met step therapy requirement (Cimzia, Enbrel, adalimumab, infliximab, or Simponi)

Approval duration

6 months initial, 1 year reauthorization