Kevzara (sarilumab) — United Healthcare
active polyarticular juvenile idiopathic arthritis
Initial criteria
- Diagnosis of active polyarticular juvenile idiopathic arthritis
- AND Patient is not receiving Kevzara in combination with another targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Xeljanz/Xeljanz XR (tofacitinib)]
Reauthorization criteria
- Documentation of positive clinical response to Kevzara therapy
- AND Patient is not receiving Kevzara in combination with another targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Olumiant (baricitinib), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Xeljanz/Xeljanz XR (tofacitinib)]
Approval duration
12 months