Rinvoq — United Healthcare

Atopic dermatitis

Initial criteria

Patient is currently on Rinvoq therapy as documented by claims history or submission of medical records (document date and duration of therapy)
Patient has not received a manufacturer supplied sample at no cost in the prescriber’s office, or any form of assistance from the Abbvie sponsored Rinvoq Complete program as a means to establish as a current user of Rinvoq
Patient is not receiving Rinvoq in combination with either of the following: (a) Targeted immunomodulator [e.g., Adbry (tralokinumab-ldrm), Dupixent (dupilumab), Cibinqo (abrocitinib), Ebglyss (lebrikizumab-lbkz), Nemluvio (nemolizumab-ilto), Xeljanz/XR (tofacitinib), Olumiant (baricitinib), Opzelura (topical ruxolitinib)] OR (b) Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)
Prescribed by a dermatologist OR allergist OR immunologist

Documentation of positive clinical response to Rinvoq therapy
Patient is not receiving Rinvoq in combination with either of the following: (a) Targeted immunomodulator [same list as above] OR (b) Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)
Prescribed by or in consultation with a dermatologist OR allergist OR immunologist

12 months