Rinvoq LQ — United Healthcare

Initial criteria

• Diagnosis of active polyarticular juvenile idiopathic arthritis
• One of the following: (a) History of failure, contraindication, or intolerance to at least one TNF inhibitor; OR (b) Documented needle-phobia; OR (c) Patient currently on Rinvoq or Rinvoq LQ therapy and has not received manufacturer sample/assistance
• Patient is not receiving Rinvoq or Rinvoq LQ in combination with targeted immunomodulator or potent immunosuppressant