ModifiedColorado Rocky Mountain Health PlansPolicy 2025 P 3177-3

Step Therapy Olumiant

Defines a step therapy program requiring trial of preferred alternatives before coverage of Olumiant (baricitinib) for rheumatoid arthritis and allows continuation for current users; applies to UnitedHealthcare Pharmacy clinical programs effective 2025-06-01.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyStep Therapy Olumiant

Policy CodePolicy 2025 P 3177-3

Change TypeStep therapy program created and subsequent clarifications/footnote updates

Effective DateJun 1, 2025

Next Review Date

Key ActionMembers new to Olumiant must meet step therapy criteria (trial/failure/intolerance/contraindication to two preferred products or meet current-user exception) prior to coverage; initial authorization required.

SourceLink

POLICY UPDATE CHANGES

New step therapy program for Olumiant (baricitinib) initiated 2/2024.

Updated RA step requirement 10/2024 to note specific preferred adalimumab products (Adalimumab-adaz Hyrimoz, Amjevita for Nuvaila, and Humira) with no change to clinical intent.

Removed examples for adalimumab step therapy and added footnote referencing drug coverage tools 4/2025.

12Authorization Duration

2Required preferred-product trials for new RA patients

2025-06-01Program effective date

What Is Changing — Coverage Summary

Step therapy requires trial of lower-cost preferred products prior to coverage of Olumiant (baricitinib). The program establishes a new step therapy requirement for Olumiant and applies to rheumatoid arthritis (RA) by requiring trials of preferred alternatives before coverage; for other diagnoses Olumiant will be approved with no further criteria specified. The program is effective 2025-06-01, and members currently on Olumiant as documented in claims history will be allowed to continue their current therapy (current users are excepted).

Key policy stats

Authorization Duration12 months

Required preferred-product trials for new RA patients2

Program effective date2025-06-01

Policy number2025 P 3177-3

Coverage stancemixed

Step Therapy Criteria and Provider Requirements

Authorization Duration

Authorization duration: Authorization will be issued for 12 months

Prior Authorization

Step therapy prior authorization required for new patients

Members new to Olumiant must meet the step therapy prior authorization requirement: trial, failure, intolerance, or contraindication to two preferred products (document drug, date, and duration of trial) OR meet the current-user exception; initial authorization is required.

Documentation Required

Document trials and assistance history

Providers must document the drug name, date, and duration of trials of preferred products; document claims history to establish current user status and whether the patient received manufacturer-supplied samples or assistance from the Olumiant Together program.

Billing Rule

Authorization duration

Approved authorizations will be issued for 12 months; supply limits and notifications may apply and state or plan-specific mandates could impact coverage.

Prior Authorization

Automated approval allowance

UnitedHealthcare may approve initial and re-authorization based solely on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic using automated processes.

Preferred Product List & Codes

No procedural or billing codes are specified in the policy body.

Preferred product examples referenced in the RA step include Adalimumab (preferred adalimumab products), Cimzia, Enbrel, Rinvoq, Simponi, and Xeljanz/Xeljanz XR. For a full and current list of preferred products, reference the drug coverage tools.

No procedural or billing codes specified in policy bodymixed

No codes listed

Policy Update Changes

2/2024addedLatest

New step therapy program for Olumiant (baricitinib) initiated 2/2024. Program created as a new step therapy requirement.

10/2024revised

Updated RA step requirement 10/2024 to note specific preferred adalimumab products (Adalimumab-adaz Hyrimoz, Amjevita for Nuvaila, and Humira) with no change to clinical intent. Clarified examples of preferred adalimumab products; clinical intent unchanged.

4/2025revised

Removed examples for adalimumab step therapy and added footnote referencing drug coverage tools 4/2025. Footnote added: 'For a list of preferred products please reference drug coverage tools.'

P&T Approval Dates: 2/2024, 10/2024, 4/2025.

Policy effective date: 2025-06-01. Last review date: 2025-04-01.

Definitions & Safety Notes

Olumiant (baricitinib) is a Janus Kinase (JAK) inhibitor indicated for moderately to severely active rheumatoid arthritis and for severe alopecia areata; it also has an indication for COVID-19 in hospitalized adults requiring significant respiratory support. Use of Olumiant in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressants (for example, azathioprine and cyclosporine) is not recommended due to safety considerations.

Current user: A member with Olumiant therapy documented in claims history who has not been established via manufacturer samples or Olumiant Together assistance.