Orencia (abatacept) subcutaneous — Pharmacy prior authorization / step therapy coverage criteria
This document is the AvMed pharmacy prior authorization / step-edit form and clinical criteria for coverage of subcutaneous Orencia (abatacept) for rheumatoid arthritis, psoriatic arthritis, and polyarticular juvenile idiopathic arthritis. It governs prescriber documentation and step therapy requirements for AvMed members seeking pharmacy coverage of Orencia SQ.
No material clinical or coverage changes in this revision.
Coverage Criteria
Initial and continuation therapy criteria
Covered when ALL of the following are met for each selected indication
General requirements
- Indication-specific DMARDs (RA): hydroxychloroquine OR leflunomide OR methotrexate OR sulfasalazine (each trial >=3 months)
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- Preferred biologics (RA): Preferred adalimumab product OR Enbrel OR Rinvoq OR preferred tocilizumab (Actemra SC or Tyenne SC) OR Xeljanz/XRfail/contraindication/intolerance to TWO
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- Indication-specific DMARDs (PsA):
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