Rinvoq — Medica
Psoriatic Arthritis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Otezla
- Skyrizi subcutaneous (pen or syringe)
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Taltz
- Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- Patient has tried ONE of Enbrel or an adalimumab product (or Cimzia, infliximab, or Simponi counts)
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- Patient continues to have Psoriatic Arthritis and met step therapy requirement (Enbrel, adalimumab, Cimzia, infliximab, or Simponi)
Approval duration
6 months initial, 1 year reauthorization