Opzelura (ruxolitinib) — United Healthcare

Initial criteria

• Diagnosis of nonsegmental vitiligo
• Patient is not receiving Opzelura in combination with another biologic medication [e.g., Dupixent (dupilumab), Xolair (omalizumab), Rituxan (rituximab), Enbrel (etanercept), Avsola/Inflectra (infliximab)] or JAK inhibitor [e.g., Jakafi (ruxolitinib), Xeljanz (tofacitinib), Rinvoq (upadacitinib)]
• Patient is not receiving Opzelura in combination with a potent immunosuppressant medication (e.g., azathioprine, cyclosporine)

Reauthorization criteria

• Documentation of positive clinical response to therapy
• Patient is not receiving Opzelura in combination with another biologic medication [e.g., Dupixent (dupilumab), Xolair (omalizumab), Rituxan (rituximab), Enbrel (etanercept), Avsola/Inflectra (infliximab)] or JAK inhibitor [e.g., Jakafi (ruxolitinib), Xeljanz (tofacitinib), Rinvoq (upadacitinib)]
• Patient is not receiving Opzelura in combination with a potent immunosuppressant medication (e.g., azathioprine, cyclosporine)

Approval duration

12 months