Orencia SC — Medical Mutual

Initial criteria

• Patient has received a hematopoietic stem cell transplant (HSCT)
• Used for steroid-refractory chronic GVHD
• Used in combination with systemic corticosteroids following no response to first line therapies

Reauthorization criteria

• Patient has had an absence of unacceptable toxicity from the drug
• Patient has had a response to therapy with an improvement in clinical assessments (e.g., NIH scores) or patient-reported symptoms

Approval duration

initial 6 months; reauth 6 months