Olumiant (baricitinib) — Point32Health
Rheumatoid Arthritis
Preferred products
- Cimzia
- Enbrel
- Humira
- Simponi
- Rinvoq
- Xeljanz
- Actemra
- Orencia
Initial criteria
- Documented diagnosis of rheumatoid arthritis
- Patient is at least 18 years of age
- Prescribed by or in consultation with a rheumatologist
- Documentation of ONE (1) of the following:
- All of the following:
- One (1) of the following:
- Inadequate response or adverse reaction to one (1), or contraindication to all traditional disease modifying antirheumatic drugs (e.g., methotrexate, leflunomide, hydroxychloroquine, sulfasalazine)
- Previous treatment with a biologic agent indicated for the requested use
- Trial and failure with two (2), or contraindication to all of the following: Cimzia, Enbrel, Humira, Simponi, Rinvoq, Xeljanz
- Trial and failure with both, or contraindication to Actemra and Orencia
- OR the patient is new to the plan and stable on Olumiant and the prescribing physician has documented that changing to a preferred product would result in adverse clinical outcomes