Orencia SC — Medical Mutual

Initial criteria

• Prescribed by or in consultation with a rheumatologist or dermatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has responded (e.g., decreased joint pain, morning stiffness, fatigue; improved function; decreased swelling; improvement in acute phase reactants), as determined by prescriber
• Site of care medical necessity is met

Approval duration

initial 6 months; reauth 1 year