Rinvoq — United Healthcare

Initial criteria

• Diagnosis of moderately to severely active Crohn’s disease
• EITHER (a) History of failure to one conventional therapy (corticosteroids, 6-mercaptopurine, azathioprine, methotrexate) OR previously treated with targeted immunomodulator FDA-approved for Crohn’s (e.g., adalimumab, Cimzia, Stelara, Skyrizi) AND history of failure, contraindication, or intolerance to at least one TNF inhibitor OR documented needle-phobia; OR (b) Patient currently on Rinvoq therapy and has not received manufacturer sample/assistance
• Patient is not receiving Rinvoq in combination with either of the following: (a) Targeted immunomodulator [e.g., adalimumab, Enbrel, Cimzia, Simponi, Orencia, Xeljanz, Olumiant, Stelara, Skyrizi] OR (b) Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)
• Prescribed by or in consultation with a gastroenterologist

Reauthorization criteria

• Documentation of positive clinical response to Rinvoq therapy
• Patient is not receiving Rinvoq in combination with either targeted immunomodulator [same list] OR potent immunosuppressant

Approval duration

12 months