Arcalyst (rilonacept) prior authorization policy
Defines prior authorization/notification coverage criteria, initial and reauthorization rules, and program controls for Arcalyst (rilonacept) including indications CAPS, DIRA (maintenance of remission), and recurrent pericarditis for applicable members. Also notes automated approval based on claim history and potential supply limits or state mandates.
Added coverage criteria for deficiency of IL-1 receptor antagonist (DIRA) and recurrent pericarditis in 5/2021.
Annual review with no change to coverage criteria in 5/2023, 5/2024, and 5/2025.
Change control history documents prior adjustments to criteria (e.g., removal/addition of IL-1 agents requirement, age changes) in years 2013-2016.
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