Kevzara — Medical Mutual

Initial criteria

• Patient weighs ≥ 63 kg
• Kevzara is prescribed by or in consultation with a rheumatologist
• Patient has tried one other systemic therapy for this condition (e.g., methotrexate, sulfasalazine, leflunomide, NSAID, biologic other than requested drug; biosimilar of requested drug does not count) OR patient will be starting Kevzara concurrently with methotrexate, sulfasalazine, or leflunomide OR patient has an absolute contraindication to methotrexate, sulfasalazine, or leflunomide (e.g., pregnancy, breastfeeding, alcoholic liver disease, immunodeficiency syndrome, blood dyscrasias) OR patient has aggressive disease as determined by the prescriber

Reauthorization criteria

• Patient has been established on therapy ≥ 6 months
• Patient experienced a beneficial clinical response compared with baseline as assessed by at least one objective measure (e.g., MD global, Parent/Patient global, JDAS, cJDAS, JSpADA, C-reactive protein, ESR, reduced corticosteroid dosage) OR patient experienced improvement in at least one symptom compared with baseline (e.g., improved motion, less joint pain, reduced stiffness or fatigue, improved function/ADL)

Approval duration

initial 6 months, reauth 1 year