Rinvoq — Medica
Ulcerative Colitis
Preferred products
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Omvoh subcutaneous
- Skyrizi subcutaneous (on-body injector)
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Tremfya subcutaneous
- Velsipity
- Zymfentra
Initial criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- Patient has tried ONE adalimumab product (or infliximab product or Simponi subcutaneous counts)
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Rinvoq/LQ Prior Authorization Policy criteria
- Patient continues to have Ulcerative Colitis and met step therapy requirement (adalimumab, infliximab, or Simponi)
Approval duration
6 months initial, 1 year reauthorization