penicillamine tablets — Point32Health

Initial criteria

• Documented diagnosis of rheumatoid arthritis
• Prescribed by or in consultation with a rheumatologist
• Documentation of one (1) of the following: a. Trial and failure with one (1) of the following: methotrexate, leflunomide, hydroxychloroquine, sulfasalazine; OR b. Clinical rationale to avoid use of all of the following: methotrexate, leflunomide, hydroxychloroquine, sulfasalazine