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Orencia (abatacept) — United Healthcare

Psoriatic Arthritis

Preferred products

  • preferred adalimumab products
  • Cimzia (certolizumab)
  • Cosentyx (secukinumab)
  • Enbrel (etanercept)
  • Rinvoq (upadacitinib)
  • Simponi (golimumab)
  • Skyrizi (risankizumab-rzaa)
  • preferred ustekinumab products
  • Tremfya (guselkumab)
  • Xeljanz/Xeljanz XR (tofacitinib)

Initial criteria

  • Diagnosis of active psoriatic arthritis
  • AND One of the following:
  • a) Both of the following:
  • i. One of the following:
  • • History of failure to a 3 month trial of methotrexate at maximally indicated dose unless contraindicated or with clinically significant adverse effects (document date and duration of trial)
  • OR • Patient has been previously treated with a targeted immunomodulator FDA-approved for psoriatic arthritis (documented by claims history or medical records) [e.g., Cimzia, adalimumab, Simponi, ustekinumab, Tremfya, Xeljanz/Xeljanz XR, Otezla, Skyrizi, Enbrel]
  • AND ii. One of the following:
  • • History of failure, contraindication, or intolerance to two of the following preferred products (document drug, date, and duration of trial):
  • 1. One of the preferred adalimumab products
  • 2. Cimzia (certolizumab)
  • 3. Cosentyx (secukinumab)
  • 4. Enbrel (etanercept)
  • 5. Rinvoq (upadacitinib)
  • 6. Simponi (golimumab)
  • 7. Skyrizi (risankizumab-rzaa)
  • 8. One of the preferred ustekinumab products
  • 9. Tremfya (guselkumab)
  • 10. Xeljanz/Xeljanz XR (tofacitinib)
  • OR b) Both of the following:
  • 1. Patient is less than 18 years of age
  • AND 2. History of failure, contraindication, or intolerance to a preferred ustekinumab product or Enbrel (etanercept) (document date and duration of trial)
  • OR c) Both of the following:
  • i. Patient is currently on Orencia therapy as documented by claims history or submission of medical records (document date and duration of therapy)
  • AND ii. Patient has not received a manufacturer supplied sample or Orencia Co-Pay Program assistance as means to establish as a current user
  • AND Patient is not receiving Orencia in combination with another targeted immunomodulator [e.g., Enbrel, Cimzia, Simponi, adalimumab, ustekinumab, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla]
  • AND Prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

  • Documentation of positive clinical response to Orencia therapy
  • AND Patient is not receiving Orencia in combination with another targeted immunomodulator [e.g., Enbrel, Cimzia, Simponi, adalimumab, ustekinumab, Skyrizi, Tremfya, Cosentyx, Taltz, Xeljanz, Olumiant, Rinvoq, Otezla]

Approval duration

12 months