Xeljanz — Medica
Juvenile Idiopathic Arthritis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Xeljanz/XR Prior Authorization Policy criteria; AND
- Patient meets ONE of the following:
- • Has tried ONE of Enbrel or an adalimumab product (a trial of Cimzia, an infliximab product, or Simponi Aria also counts); OR
- • Has been established on Xeljanz for ≥90 days and prescription claims history indicates at least a 90‑day supply of Xeljanz was dispensed within the past 130 days, or verification by prescriber if claims data unavailable.
Approval duration
1 year