Ilaris — Medical Mutual
Systemic Juvenile Idiopathic Arthritis (SJIA)
Initial criteria
- Patient age ≥ 2 years
- Meets one of: (a) Tried ≥ 2 other biologics OR (b) Has poor prognosis and tried Actemra or Kineret OR (c) Features with concerns of progression to macrophage activation syndrome AND tried Kineret
- Prescribed by or in consultation with a rheumatologist
- 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
Approval duration
initial 6 months, reauth 1 year