Ilaris — Medical Mutual
Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD)
Initial criteria
- Patient age ≥ 2 years
- Prior to starting: C-reactive protein ≥ 10 mg/L OR ≥ 2x ULN AND patient has ≥ 3 febrile acute flares in past 6 months OR hospitalized for severe flare
- Prescribed by or in consultation with a rheumatologist, nephrologist, geneticist, oncologist, or hematologist
- 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 OR improved symptoms compared with baseline (e.g. decreased pain, stiffness, swelling, fatigue, improved function or ADLs)
Approval duration
initial 6 months, reauth 1 year