Kevzara (sarilumab) — United Healthcare
active polyarticular juvenile idiopathic arthritis (pJIA)
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, Enbrel, Olumiant, Orencia, Rinvoq, Simponi, Xeljanz/Xeljanz XR]
- AND Prescribed by or in consultation with a rheumatologist
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, Enbrel, Olumiant, Orencia, Rinvoq, Simponi, Xeljanz/Xeljanz XR]
Approval duration
12 months