Xeljanz oral solution — Medica
Juvenile Idiopathic Arthritis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
Initial criteria
- Patient meets the standard Inflammatory Conditions – Xeljanz/XR Prior Authorization Policy criteria; AND
- Patient has tried ONE of Enbrel or an adalimumab product (a trial of Cimzia, an infliximab product, or Simponi Aria also counts).
Approval duration
6 months