Tyenne subcutaneous — Medica

Preferred products

• Enbrel
• adalimumab-adbm
• Cyltezo
• adalimumab-adaz
• adalimumab-ryvk
• Simlandi

Initial criteria

• Patient meets the standard Inflammatory Conditions – Tocilizumab Subcutaneous Prior Authorization Policy criteria
• Patient has Polyarticular Juvenile Idiopathic Arthritis or Rheumatoid Arthritis AND has tried one adalimumab product (e.g., Humira, Abrilada, adalimumab-adaz, adalimumab-adbm, adalimumab-fkjp, adalimumab-aaty, adalimumab-ryvk, Simlandi, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry) OR trial of Enbrel, Cimzia, an infliximab product (e.g., Remicade, biosimilars), or Simponi (Aria or subcutaneous) counts OR According to the prescriber, patient has heart failure or previously treated lymphoproliferative disorder OR patient established on tocilizumab IV for ≥90 days OR established on tocilizumab SC for ≥90 days within past 130 days verified by claims or prescriber

Approval duration

1 year