Kineret — Medical Mutual

Initial criteria

• Patient meets ONE of the following: tried ONE systemic agent (corticosteroid OR conventional synthetic DMARD); OR tried ONE biologic DMARD/TNF inhibitor/Ilaris; OR tried a 1-month trial of an NSAID; OR has at least moderate to severe active systemic features OR active joint count ≥1; OR has active systemic features with concerns of progression to MAS
• Kineret is prescribed by or in consultation with a rheumatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has responded (e.g., improved limitation of motion; less joint pain or tenderness; decreased duration of morning stiffness or fatigue; improved function or activities of daily living; reduced dosage of corticosteroids), as determined by the prescriber
• Site of care medical necessity is met

Approval duration

initial 6 months; reauth 1 year