Kevzara (sarilumab) — United Healthcare

Initial criteria

• Diagnosis of polymyalgia rheumatica (PMR)
• AND Patient has had an inadequate response to corticosteroids or cannot tolerate corticosteroid taper
• 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