Updated criteria for RA (removed requirement for TNF inhibitor first); psoriatic arthritis (removed NSAID requirement and added Stelara to preferred agent); and ulcerative colitis (requires trial of BOTH preferred biologics - Humira and Simponi).
Updated prerequisite drugs to include Xeljanz/XR and Rinvoq and trial of both Actemra and Orencia.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.