Rinvoq — Medica
Other inflammatory conditions
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Taltz
- Omvoh subcutaneous
- Skyrizi subcutaneous
- Stelara subcutaneous
- Zymfentra
- Otezla
- Tremfya subcutaneous
- Velsipity
Initial criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- AND Patient meets ONE of the following:
- a) For Ankylosing Spondylitis: tried one of Enbrel or an adalimumab product (trial of Cimzia, an infliximab product, or Simponi also counts)
- b) For Crohn’s Disease: tried one adalimumab product (trial of infliximab product or Cimzia also counts)
- c) For Juvenile Idiopathic Arthritis: tried one of Enbrel or an adalimumab product (trial of Cimzia, an infliximab product, or Simponi Aria also counts)
- d) For nr-axSpA: tried Cimzia (trial of Enbrel, adalimumab product, infliximab product, or Simponi also counts)
- e) For Rheumatoid Arthritis: tried one of Enbrel or an adalimumab product (trial of Cimzia, infliximab product, or Simponi also counts)
- f) For Psoriatic Arthritis: tried one of Enbrel or an adalimumab product (trial of Cimzia, infliximab product, or Simponi also counts)
- g) For Ulcerative Colitis: tried one adalimumab product (trial of infliximab product or Simponi subcutaneous also counts)
- h) Patient established on Rinvoq ≥ 90 days with ≥ 90‑day supply dispensed within past 130 days verified by claims or prescriber
Reauthorization criteria
- Patient continues to meet the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- For patients currently established on Rinvoq: same criteria as initial apply or patient verified as established on therapy ≥ 90 days
Approval duration
6 months for initial therapy; 1 year for continuation or as directed for other conditions