Ilaris — Medical Mutual

Cryopyrin-Associated Periodic Syndromes (CAPS) including Familial Cold Autoinflammatory Syndrome (FCAS), Muckle-Wells Syndrome (MWS), Neonatal Onset Multisystem Inflammatory Disease (NOMID), Chronic Infantile Neurological Cutaneous and Articular (CINCA) Syndrome

Initial criteria

Patient age ≥ 4 years
Prescribed by or in consultation with a rheumatologist, geneticist, allergist/immunologist, or dermatologist
Genetic test shows mutation in CIAS1/NLRP3
Will not be used concurrently with other biologics
Will not be used to treat rheumatoid arthritis

Reauthorization criteria

Patient established on medication ≥ 6 months AND
Beneficial clinical response by objective measure (e.g. fever resolution, rash improvement, normalized serum markers, reduced proteinuria, stabilized creatinine) OR improved symptoms compared with baseline (e.g. fewer cold-induced attacks, less joint pain/tenderness, stiffness, swelling, decreased fatigue, improved function or ADLs)

Approval duration

initial 6 months, reauth 1 year