CurrentColorado Rocky Mountain Health PlansPolicy N/A

Kevzara (sarilumab) prior authorization

Prior authorization and reauthorization requirements for Kevzara (sarilumab) injections for covered indications (rheumatoid arthritis, polymyalgia rheumatica, and polyarticular juvenile idiopathic arthritis) for UnitedHealthcare Pharmacy Clinical Pharmacy Programs.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyKevzara (sarilumab) prior authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionDocument diagnosis and required prior therapy or positive clinical response as specified for initial authorization and reauthorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3covered indications listed

12 moauthorization duration

PA/Notificationutilization management

8/2025P&T approval through

Coverage Criteria for Kevzara (sarilumab)

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Initial Therapy - Rheumatoid Arthritis

Covered when ALL of the following are met

RA initial: (1) Diagnosis of moderately to severely active rheumatoid arthritis; (2) patient has had an inadequate response or intolerance to one or more disease-modifying anti-rheumatic drugs (DMARDs) (e.g., methotrexate, leflunomide, sulfasalazine); (3) patient is not receiving Kevzara in combination with another targeted immunomodulator (e.g., adalimumab, certolizumab, etanercept, baricitinib, abatacept, upadacitinib, golimumab, tofacitinib)