Rinvoq — Medical Mutual

Initial criteria

• Patient age ≥ 12 years
• Patient had a 4-month trial of ≥1 systemic therapy OR unable to tolerate 4-month trial
• Rinvoq prescribed by or in consultation with an allergist, immunologist, or dermatologist

Reauthorization criteria

• Patient established on therapy ≥ 90 days
• Patient experienced a beneficial response, defined as improvement in at least one measure (affected body surface area, erythema, induration/papulation/edema, excoriations, lichenification, decreased requirement of other therapies)
• Patient experienced symptom improvement such as decreased itching

Approval duration

initial 3 months; renewal 1 year