Olumiant — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient has had a 3-month trial of at least ONE tumor necrosis factor inhibitor OR patient has tried at least one tumor necrosis factor inhibitor but was unable to tolerate a 3-month trial; AND
• The medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on the requested drug for at least 6 months; AND
• Patient experienced a beneficial clinical response when assessed by at least one objective measure OR patient experienced an improvement in at least one symptom (e.g., decreased joint pain, morning stiffness, fatigue, function or activities of daily living, decreased soft tissue swelling in joints or tendon sheaths)

Approval duration

initial: 6 months; reauth: 1 year