Kineret — Medical Mutual

Initial criteria

• Patient has had a 3-month trial of a biologic DMARD OR targeted synthetic DMARD for this condition, unless intolerant
• Kineret is prescribed by or in consultation with a rheumatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has had a response (e.g., less joint pain, morning stiffness, or fatigue; improved function or activities of daily living; decreased soft tissue swelling in joints or tendon sheaths; improved laboratory values; reduced dosage of corticosteroids), as determined by the prescriber
• Site of care medical necessity is met

Approval duration

initial 6 months; reauth 1 year