Rinvoq — Medica
Rheumatoid Arthritis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
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 Rheumatoid Arthritis and met step therapy requirement (Enbrel, adalimumab, Cimzia, infliximab, or Simponi)
Approval duration
6 months initial, 1 year reauthorization