Orencia SC — Medical Mutual

Initial criteria

• Age ≥ 2 years
• Moderately to severe polyarticular juvenile idiopathic arthritis
• Abatacept will not be used in combination with another biologic agent (e.g., adalimumab, anakinra, certolizumab pegol, etanercept, infliximab, golimumab, rituximab, tocilizumab), Otezla or Xeljanz
• Prescribed by or in consultation with a rheumatologist
• Patient has tried one other agent for this condition (e.g., methotrexate, sulfasalazine, leflunomide, NSAID, or a prior biologic) OR starting Orencia concurrently with methotrexate, sulfasalazine, or leflunomide OR absolute contraindication to methotrexate, sulfasalazine, or leflunomide OR patient has aggressive disease as determined by prescriber
• Site of care medical necessity is met

Reauthorization criteria

• Patient has had a response (e.g., improved limitation of motion, less joint pain/tenderness, improved function/ADLs, decreased morning stiffness or fatigue, reduced corticosteroid use, decreased swelling, improved labs), as determined by the prescriber
• Site of care medical necessity is met

Approval duration

initial 6 months; reauth 1 year