Rinvoq — Medical Mutual

Initial criteria

• Patient age > 18 years
• Patient has had a 3-month trial of at least one tumor necrosis factor inhibitor OR patient has tried at least one tumor necrosis factor inhibitor but was unable to tolerate 3-month trial
• Rinvoq is prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• Patient experienced a beneficial clinical response when assessed by ≥ 1 objective measure from baseline OR compared with baseline patient experienced an improvement in ≥ 1 symptom such as decreased pain, fatigue, stool frequency, and/or blood in stool

Approval duration

initial 6 months; renewal 1 year