Rinvoq — United Healthcare

Giant Cell Arteritis (GCA)

Initial criteria

(1) Diagnosis of giant cell arteritis
AND (2) Patient is not receiving Rinvoq in combination with either of the following: (a) Targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Olumiant (baricitinib), tocilizumab, Xeljanz (tofacitinib)] (b) Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)
AND (3) Prescribed by or in consultation with a rheumatologist

(1) Documentation of positive clinical response to Rinvoq therapy
AND (2) Patient is not receiving Rinvoq in combination with either of the following: (a) Targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Olumiant (baricitinib), tocilizumab, Xeljanz (tofacitinib)] (b) Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)

12 months