Ilaris — Medical Mutual
Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS)
Initial criteria
- Patient age ≥ 2 years
- Prior to starting: C-reactive protein ≥ 10 mg/L OR ≥ 2x ULN AND history of ≥ 6 flares per year OR hospitalization for severe flare
- Prescribed by or in consultation with a rheumatologist, geneticist, nephrologist, 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
Approval duration
initial 6 months, reauth 1 year