Orencia SC — Medical Mutual

Initial criteria

• Age > 18 years
• Moderately to severe rheumatoid arthritis
• The patient has tried ONE conventional synthetic DMARD for at least 3 months OR has an intolerance to or unable to receive methotrexate or other non-biologic DMARD (e.g., hydroxychloroquine, leflunomide, sulfasalazine, minocycline) OR The patient has tried ONE biologic DMARD for 3 months
• Prescribed by or in consultation with a rheumatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response when assessed by at least one objective measure OR experienced an improvement in at least one symptom (e.g., decreased joint pain, morning stiffness, fatigue; improved function or activities of daily living; decreased swelling)

Approval duration

initial 6 months; reauth 1 year