Adalimumab — United Healthcare

Initial criteria

• Diagnosis of moderately to severely active polyarticular juvenile idiopathic arthritis
• Patient is not receiving adalimumab in combination with another targeted immunomodulator (e.g., Enbrel, Cimzia, Simponi, Orencia, Xeljanz, Olumiant, Rinvoq)
• Prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Documentation of positive clinical response to adalimumab therapy
• Patient is not receiving adalimumab in combination with another targeted immunomodulator (e.g., Enbrel, Cimzia, Simponi, Orencia, Xeljanz, Olumiant, Rinvoq)

Approval duration

12 months