Adherence to Non-Infused Biologic Medications Used to Treat Rheumatoid Arthritis (PDC-RA)
|
|
- Sharlene Little
- 5 years ago
- Views:
Transcription
1 Adherence to Non-Infused Biologic Medications Used to Treat Rheumatoid Arthritis (PDC-RA) Description The percentage of patients 18 years and older with rheumatoid arthritis (RA) who met the Proportion of Days Covered (PDC) threshold of 80% during the measurement period for biologic medications used to treat RA. A higher rate indicates better performance. Intended Use Intended Use Performance measurement for health plans Definitions Biologic Medications Used to Treat Rheumatoid Arthritis Non-Infused Biologic Medications Used to Treat RA Infused Biologic Medications Used to Treat RA (Exclusion) Measurement Year Proportion of Days Covered (PDC) PDC Threshold Index Prescription Start Date (IPSD) Treatment Period Prescription Claims Rheumatoid Arthritis Diagnosis Each biologic medication included in the measure has an indication for use for RA. The biologic medications may also be used to treat other inflammatory conditions; however, this measure is intended to assess adherence only for those being treated for RA. See Medication Table PDC-RA-A: Non-Infused Biologic Medications Used to Treat RA. See Medication Table PDC-RA-B: Infused Biologic Medications Used to Treat RA (Exclusion). The calendar year (January 1 through December 31) when the measure is assessed. The proportion of days in the measurement period covered by prescription claims for the same medication or another in its therapeutic category. The level of PDC above which the medication has a reasonable likelihood of achieving most of the potential clinical benefit (80% for this measure). The earliest date of service for a non-infused biologic treating RA during the measurement year. The patient s treatment period begins on the IPSD and extends through whichever comes first: the last day of the measurement year, death or disenrollment. The IPSD should occur at least 91 days before the end of the enrollment period. Only paid, non-reversed prescription claims are included in the data set to calculate the measure. Patients with a rheumatoid arthritis diagnosis during the measurement year. See the PQA ICD Code Value Set, Rheumatoid Arthritis.
2 A rheumatoid arthritis diagnosis is defined as having at least one claim with any of the listed RA diagnoses, including primary diagnosis or any other diagnosis fields during the measurement year. Eligible Population Ages Continuous Enrollment Allowable Gap for Medicaid Benefit 18 years and older as of the first day of the measurement year. Subjects should be continuously enrolled during the treatment period. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 consecutive days] is not considered continuously enrolled.) Medical and Pharmacy. Event/Diagnosis A rheumatoid arthritis diagnosis during the measurement year AND Two or more prescription claims for non-infused biologic medications used to treat RA (see Table PDC-RA-A) on two unique dates of service, for which the sum of the days supply is 56 days or greater during the treatment period. Use the steps below to determine the eligible population. Step 1 Step 2 Step 3 Identify patients with a rheumatoid arthritis diagnosis during the measurement year. Identify patients with two or more prescription claims for non-infused biologic medications used to treat RA (see Table PDC-RA-A) filled on two unique dates of service, for which the sum of the days supply is 56 days or greater during the treatment period. Exclude patients with one or more claims for an infused biologic used to treat RA (see Table PDC-RA: B) during the treatment period. NOTE: Use both pharmacy claims (NDCs) and medical claims (NDCs and HCPCS) to identify infused biologic medications. In addition to the PQA NDC list, see PDC RA HCPCS Exclusion List. Administrative Specification Data Sources Denominator Numerator Prescription and medical claims data. The eligible population. The number of patients in the denominator that met the PDC threshold during the measurement year. Follow the steps below for each patient to determine whether the patient meets the PDC threshold. Step 1 Step 2 Determine the patient s treatment period, defined as IPSD to the end of the enrollment year, disenrollment, or death. Within the treatment period, count the days the patient was covered by a least one drug in the class based on the prescription fill date and days of supply. If prescriptions for the same drug (generic ingredient) overlap, then adjust the prescription start date to be the day after the previous fill has ended.*
3 Step 3 Step 4 Divide the number of covered days found in Step 2 by the number of days found in Step 1. Multiply this number by 100 to obtain the PDC (as a percentage) for each patient. Count the number of patients who had a PDC of 80% or greater and then divide by the total number of eligible patients. *Adjustment of overlap should also occur when there is overlap of a single drug product to a combination product containing the target drug or when there is an overlap of a combination product to another combination product where there is overlap of at least the target drug. An example of SAS code for steps 1-3 is available from PQA upon request, and is also available at the URL: Stratification Commercial, Medicaid, Medicare (report each product line separately). For Medicare, report rates for low-income subsidy (LIS) and non-lis populations separately. Medication Tables PDC-RA-A: Non-Infused Biologic Medications Used to Treat RA Tumor Necrosis Factor Alpha Blockers certolizumab pegol (SC) Interleukin-1 Receptor Antagonist (IL-1Ra) anakinra (SC) Interleukin-6 Receptor Antagonist (IL-6Ra) sarilumab (SC) tocilizumab (SC) Anti-TNF-alpha - Monoclonoal Antibodies adalimumab (SC) adalimumab-atto (SC) golimumab (SC) adalimumab-adbm (SC) Soluble Tumor Necrosis Factor Receptor Agents etanercept (SC) etanercept-szzs Selective Costimulation Modulators abatacept (SC) Janus Kinase (JAK) Inhibitors tofacitinib (Oral) SC = subcutaneous Table PDC-RA-B: Infused Biologic Medications Used to Treat RA (Exclusion) a Antineoplastic - Monoclonal Antibodies rituximab (IV) Interleukin-1 Receptor Antagonist (IL-1Ra) infliximab (IV) infliximab-abda infliximab-dyyb Interleukin-6 Receptor Antagonist (IL-6Ra) tocilizumab (IV) Anti-TNF-alpha - Monoclonoal Antibodies golimumab (IV) Soluble Tumor Necrosis Factor Receptor Agents abatacept (IV) IV = intravenous a Use both pharmacy claims (NDCs) and medical claims (NDCs and HCPCS) to identify infused biologic medications Rationale Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disease that can lead to premature mortality and reduce a person s health and quality of life. 1 RA affects an estimated million Americans, 2-3 and while one study found that prevalence decreased from 1995 to , another found an increase in overall prevalence from 2005 to Certain genetic traits, environmental causes, and lifestyle behaviors are thought to contribute to RA s etiology. 4 RA is 2 to 3 times more likely in women
4 than men 1-3 and, it is estimated that morbidity, mortality, and disability due to RA are likely to increase in older adults. 2 RA is also a significant driver of costs for both treatment of the disease and its complications, causing a substantial impact on both direct healthcare costs and indirect costs associated with productivity loss, absenteeism, and disability. 5-7 In 2015, it was estimated that the national indirect costs of RA-related absenteeism were $252 million annually. 8 However, appropriate treatment can prevent loss of function and improve patients quality of life. 9 Most RA patients require continuous treatment to control flares and disease progression. 4,10 Current evidence-based guidelines from the American College of Rheumatology recommend the use of selfinjectable, biologic disease-modifying antirheumatic drugs (DMARDs) for both early symptomatic and well-established disease. 9 Biologic DMARDs are frequently used in combination with synthetic DMARDs or corticosteroids to manage symptoms and control disease progression. 1,9 Although biologic treatments are considerably more expensive than traditional oral treatments, for many patients they offer improved efficacy, reduced disability, and improved quality of life. 1 The full benefits of self-injectable biologic treatments can only be achieved when patients are adherent to their medication regimen; however, many patients have difficulty taking their medications as often as directed. Nonadherent populations have been shown to be at a higher risk of flare-up, and overall, they experience more frequent flares compared to those who were more adherent to therapy. 11 Currently, nonadherence rates range from 20-70% Higher adherence levels for patients result in a reduction in health care expenditures and improvements in quality of life. 6-7 Thus, improvements in RA medication adherence would be expected to moderate disease progression, reducing the utilization of medical services and the associated costs. 1, 6-7 References 1. Donahue KE, Gartlehner G, Jonas DE, et al; for the Agency for Healthcare Research and Quality. Comparative Effectiveness Of Drug Therapy For Rheumatoid Arthritis And Psoriatic Arthritis In Adults. Comparative Effectiveness Review No.11. AHRQ publication. 08-EHC004-EF. Published November Accessed November 1, Helmick CG, Felson DT, Lawrence RC, et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58(1): Myasoedova E, Crowson CS, Kremers HM, et al. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, Arthritis Rheum. 2010;62(6): Rheumatoid Arthritis. Centers for Disease Control and Prevention. Available at: Accessed November 15, Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis: Pharmacoeconomics. 2004;22(2)(suppl 1): Burton W, Morrison A, Maclean R, Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond). 2006;56(1): Xie F. The need for standardization: a literature review of indirect costs of rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 2008;59(7): Gunnarsson C, et al. The Employee Absenteeism Costs of Rheumatoid Arthritis: Evidence From US National Survey Data. Journal of Occupational and Environmental Medicine Singh JA, Saag KG, Bridges SL, et al. (2016), 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research, 68: Doi: /acr Curtis JR, Singh JA. The Use of Biologics in Rheumatoid Arthritis: Current and Emerging Paradigms of Care. Clinical therapeutics. 2011;33(6): doi: /j.clinthera
5 11. Contreras-yáñez I, Ponce de león S, Cabiedes J, Rull-gabayet M, Pascual-ramos V. Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Med Sci. 2010;340(4): Pascual-Ramos V, Contreras-Yáñez I, Villa AR, Cabiedes J, Rull-Gabayet M. Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthritis Research & Therapy. 2009;11(1):R26. doi: /ar Harnett J, Wiederkehr D, Gerber R, Gruben D, Bourret J, Koenig A. Primary Nonadherence, Associated Clinical Outcomes, and Health Care Resource Use Among Patients with Rheumatoid Arthritis Prescribed Treatment with Injectable Biologic Disease-Modifying Antirheumatic Drugs. J Manag Care Spec Pharm. 2016;22(3):
Proposed Retirement for HEDIS : Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART)
Proposed Retirement for HEDIS 1 2020 2 : Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) NCQA seeks public comment on the proposed retirement of the Disease-Modifying Anti-Rheumatic
More informationRegulatory Status FDA-approved indication: Orencia is a selective T cell costimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.18 Subject: Orencia Page: 1 of 8 Last Review Date: March 16, 2018 Orencia Description Orencia (abatacept)
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: golimumab_simponi 8/2013 2/2018 2/2019 3/2018 Description of Procedure or Service Golimumab (Simponi and
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: abatacept_orencia 4/2008 2/2018 2/2019 2/2018 Description of Procedure or Service Abatacept (Orencia ), a
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process
Quality ID #337: Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis on a Biological Immune Response Modifier National Quality Strategy Domain:
More informationRheumatoid arthritis (RA) is a chronic disease that requires
ORIGINAL RESEARCH Two-Year Adherence and Costs for Biologic Therapy for Rheumatoid Arthritis Bradley S. Stolshek, PharmD; Sally Wade, MPH; Alex Mutebi, PhD, MSc; Ajita P. De, MA, MPhil, MS; Rolin L. Wade,
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC)
DERBYSHIRE JOINT AREA PRERIBING COMMITTEE (JAPC) Derbyshire commissioning guidance on biologic drugs f the treatment of Rheumatoid arthritis with methotrexate This algithm is a tool to aid the implementation
More information(tofacitinib) are met.
Xeljanz (tofacitinib) Policy Number: 5.01. 560 Origination: 3/2014 Last Review: 3/2014 Next Review: 3/2015 Policy BCBSKC will provide coverage for Xeljanz (tofacitinib) when it is determined to be medically
More informationCimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.11 Section: Prescription Drugs Effective Date: April 1, 2018 Subject: Cimzia Page: 1 of 5 Last Review
More informationRHEUMATOID ARTHRITIS DRUGS
Rheumatology Biologics Criteria from the Exceptional Access Program RHEUMATOID ARTHRITIS DRUGS DRUG NAME BRS REIMBURSED DOSAGE FORM/ STRENGTH Adalimumab Humira 40 mg/0.8 syringe and 40mg/0.8 pen for Anakinra
More information2017 Medicare STARs Provider Quality Indicators Guide
2017 Medicare STARs Provider Quality Indicators Guide Medicare STARs Rating Centers for Medicare & Medicaid Services (CMS) created a Five-Star Quality Rating System to help measure the quality in care
More informationTechnology appraisal guidance Published: 11 October 2017 nice.org.uk/guidance/ta480
Tofacitinib for moderate to severeere rheumatoid arthritis Technology appraisal guidance Published: 11 October 2017 nice.org.uk/guidance/ta480 NICE 2018. All rights reserved. Subject to Notice of rights
More informationPharmacy Medical Necessity Guidelines: Orencia (abatacept)
Pharmacy Medical Necessity Guidelines: Effective: October 23, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review SQ: RXUM/ RX / Pharmacy (RX) or
More informationStelara. Stelara (ustekinumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.90.04 Subject: Stelara Page: 1 of 9 Last Review Date: September 20, 2018 Stelara Description Stelara
More informationRegulatory Status FDA- approved indication: Simponi and Simponi ARIA are tumor necrosis factor (TNF) blockers indicated for the treatment of: (2-3)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.51 Subject: Simponi / Simponi ARIA Page: 1 of 9 Last Review Date: March 16, 2018 Simponi / Simponi
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 1097-7 Program Prior Authorization/Notification Medication *Stelara (ustekinumab) *This program applies to the subcutaneous formulation
More informationEffective Health Care Program
Comparative Effectiveness Review Number 55 Effective Health Care Program Drug Therapy for Rheumatoid Arthritis in Adults: An Update Executive Summary Background Rheumatoid arthritis (RA), which affects
More informationRheumatoid arthritis (RA) is a systemic, inflammatory,
ORIGINAL RESEARCH Compliance and Cost of Biologic Therapies for Rheumatoid Arthritis Machaon Bonafede, PhD, MPH; Barbara H. Johnson, MBA; Derek H. Tang, PhD, BSPharm; David J. Harrison, PhD; and Bradley
More informationRegulatory Status FDA-approved indication: Orencia is a selective T cell co-stimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Orencia Page: 1 of 9 Last Review Date: September 20, 2018 Orencia Description Orencia (abatacept)
More informationOrencia (abatacept) DRUG.00040
Market DC Orencia (abatacept) DRUG.00040 Override(s) Prior Authorization Quantity Limit Approval Duration 1 year Medications Comments Quantity Limit Orencia (abatacept) - AGP, VA MCD only 4 vials per 28
More informationClinical Policy: Certolizumab (Cimzia) Reference Number: PA.CP.PHAR.247 Effective Date: 01/18 Last Review Date: 08/17 Line of Business: Medicaid
Clinical Policy: (Cimzia) Reference Number: PA.CP.PHAR.247 Effective Date: 01/18 Last Review Date: 08/17 Line of Business: Medicaid Coding Implications Revision Log Description (Cimzia ) is a tumor necrosis
More informationRheumatoid Arthritis Update
Rheumatoid Arthritis Update Beth Valashinas, DO, FACOI, FACR Disclosures Speaker for AbbVie Pharmaceuticals Learning Objectives Upon completion of this session, participants should be able to discuss:
More informationCimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.11 Subject: Cimzia Page: 1 of 5 Last Review Date: December 8, 2017 Cimzia Description Cimzia (certolizumab
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
Program Number 2017 P 3041-8 Program Step Therapy Medications UnitedHealthcare Pharmacy Clinical Pharmacy Programs *Orencia (abatacept) *This step criteria refers to the subcutaneous formulation of abatacept
More informationCost-Motivated Treatment Changes in Medicare Part B:
Cost-Motivated Treatment Changes in Medicare Part B: Implications for Non- Medical Switching September 2016 THE MORAN COMPANY 1 Cost-Motivated Treatment Changes in Medicare Part B: Implications for Non-Medical
More informationCosentyx. Cosentyx (secukinumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.90.11 Subject: Cosentyx Page: 1 of 7 Last Review Date: September 20, 2018 Cosentyx Description Cosentyx
More information1 P a g e. Systemic Juvenile Idiopathic Arthritis (SJIA) (1.3) Patients 2 years of age and older with active systemic juvenile idiopathic arthritis.
LENGTH OF AUTHORIZATION: Initial: 3 months for Crohn s or Ulcerative Colitis; 1 year for all other indications. Renewal: 1 year dependent upon medical records supporting response to therapy and review
More informationAdherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritisvhe_
Volume 13 Number 6 2010 VALUE IN HEALTH Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritisvhe_764 805..812 Pengxiang Li, PhD, 1,2 Marissa A.
More informationGet an Insurance Benefits Review for ORENCIA (abatacept)
Get an Insurance Benefits Review for ORENCIA (abatacept) If you and your doctor decide that ORENCIA is right for you, you can call 1-800-ORENCIA (1-800-673-6242) to do an Insurance Benefits Review. Our
More informationXeljanz. Xeljanz, Xeljanz XR (tofacitinib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.24 Subject: Xeljanz Page: 1 of 6 Last Review Date: March 16, 2018 Xeljanz Description Xeljanz, Xeljanz
More informationCorporate Medical Policy
Corporate Medical Policy Rituximab for the Treatment of Rheumatoid Arthritis File Name: Origination: Last CAP Review: Next CAP Review: Last Review: rituximab_for_the_treatment_of_rheumatoid_arthritis 4/2008
More informationRheumatoid arthritis (RA) is a chronic and progressive
At a Glance Impact of Specialty Pharmacy on Treatment Costs for Rheumatoid Arthritis Practical Implications p SP50 Author Information p SP55 Full text and PDF Web exclusive eappendices Original Research
More informationOtezla. Otezla (apremilast) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Otezla Page: 1 of 5 Last Review Date: March 16, 2018 Otezla Description Otezla (apremilast) Background
More informationAmjevita (adalimumab-atto) CG-DRUG-64, CG-DRUG-65
Market DC Amjevita (adalimumab-atto) CG-DRUG-64, CG-DRUG-65 Override(s) Prior Authorization Quantity Limit Medications Amjevita 20 mg/0.4 ml prefilled syringe Amjevita (adalimumab-atto) 40 mg/0.8 ml 2
More informationCoverage Criteria: Express Scripts, Inc. monograph dated 12/15/ months or as otherwise noted by indication
BENEFIT DESCRIPTION AND LIMITATIONS OF COVERAGE ITEM: PRODUCT LINES: COVERED UNDER: DESCRIPTION: CPT/HCPCS Code: Company Supplying: Setting: Kineret (anakinra subcutaneous injection) Commercial HMO/PPO/CDHP
More informationTreatment of Rheumatoid Arthritis: The Past, the Present and the Future
Treatment of Rheumatoid Arthritis: The Past, the Present and the Future Lai-Ling Winchow FCP(SA) Cert Rheum(SA) Chris Hani Baragwanath Academic Hospital University of the Witwatersrand Outline of presentation
More informationAbatacept (Orencia) for active rheumatoid arthritis. August 2009
Abatacept (Orencia) for active rheumatoid arthritis August 2009 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to
More informationCyltezo (adalimumab-adbm) CG-DRUG-64, CG-DRUG-65
Market DC Cyltezo (adalimumab-adbm) CG-DRUG-64, CG-DRUG-65 Override(s) Prior Authorization Quantity Limit Medications Cyltezo (adalimumab-adbm) 40 mg/0.8 ml prefilled syringe #* ^ Approval Duration 1 year
More informationPharmacy Medical Necessity Guidelines: Actemra (tocilizumab)
Pharmacy Medical Necessity Guidelines: Effective: July 11, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review SQ: RXUM/ RX / Pharmacy (RX) or Medical
More informationTechnology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta466
Baricitinib for moderate to severeere rheumatoid arthritis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta466 NICE 2017. All rights reserved. Subject to Notice of rights
More information2017 Blue Cross and Blue Shield of Louisiana
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationCDEC FINAL RECOMMENDATION
CDEC FINAL RECOMMENDATION TOFACITINIB (Xeljanz Pfizer Canada Inc.) Indication: Rheumatoid Arthritis Recommendation: The Canadian Drug Expert Committee (CDEC) recommends that tofacitinib be listed, in combination
More informationRegulatory Status FDA-approved indications: Entyvio is an α4β7integrin receptor antagonist indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.12 Subject: Entyvio Page: 1 of 7 Last Review Date: September 20, 2018 Entyvio Description Entyvio
More informationActemra. Actemra (tocilizumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.12 Subject: Actemra Page: 1 of 13 Last Review Date: September 20, 2018 Actemra Description Actemra
More informationRegulatory Status FDA-approved indication: Orencia is a selective T cell costimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.18 Subject: Orencia Page: 1 of 6 Last Review Date: December 8, 2017 Orencia Description Orencia (abatacept)
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 1017-7 Program Prior Authorization/Notification Medication Cimzia (certolizumab) P&T Approval Date 1/2007, 6/2008, 4/2009, 6/2009,
More informationORENCIA (ABATACEPT) INJECTION FOR INTRAVENOUS INFUSION
UnitedHealthcare Community Plan Medical Benefit Drug Policy ORENCIA (ABATACEPT) INJECTION FOR INTRAVENOUS INFUSION Policy Number: CS2018D0039J Effective Date: March 1, 2018 Table of Contents Page INSTRUCTIONS
More informationClinical Policy: Sarilumab (Kevzara) Reference Number: CP.PHAR.346 Effective Date: Last Review Date: 11.18
Clinical Policy: (Kevzara) Reference Number: CP.PHAR.346 Effective Date: 07.18.17 Last Review Date: 11.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationMedication Policy Manual. Topic: Xeljanz, tofacitinib Date of Origin: January 21, 2013
Medication Policy Manual Policy No: dru289 Topic: Xeljanz, tofacitinib Date of Origin: January 21, 2013 Committee Approval Date: January 19, 2015 Next Review Date: January 2016 Effective Date: April 1,
More informationCimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Cimzia Page: 1 of 5 Last Review Date: March 17, 2017 Cimzia Description Cimzia (certolizumab pegol)
More informationClinical Policy: Baricitinib (Olumiant) Reference Number: CP.PHAR.135 Effective Date: Last Review Date: 11.18
Clinical Policy: (Olumiant) Reference Number: CP.PHAR.135 Effective Date: 07.24.18 Last Review Date: 11.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationPharmacy Management Drug Policy
SUBJECT: Cimzia (Certolizumab pegol) - for Ankylosing Spondylitis, Crohn s Disease, Psoriatic Arthritis and Rheumatoid Arthritis POLICY NUMBER: PHARMACY-07 EFFECTIVE DATE: 5/2009 LAST REVIEW DATE: 6/13/2018
More informationXeljanz (tofacitinib), Xeljanz XR (tofacitinib extended-release)
Market DC Xeljanz (tofacitinib), Xeljanz XR (tofacitinib extended-release) Override(s) Prior Authorization Quantity Limit Medications Xeljanz (tofacitinib) Approval Duration 1 year Quantity Limit May be
More informationSIMPONI ARIA (GOLIMUMAB) INJECTION FOR INTRAVENOUS INFUSION
UnitedHealthcare Commercial Medical Benefit Drug Policy SIMPONI ARIA (GOLIMUMAB) INJECTION FOR INTRAVENOUS INFUSION Policy Number: PHA031 Effective Date: March 1, 2019 Table of Contents Page COVERAGE RATIONALE...
More informationACTEMRA (tocilizumab)
ACTEMRA (tocilizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationAmjevita (adalimumab-atto)
*- Florida Healthy Kids Amjevita (adalimumab-atto) Override(s) Prior Authorization Quantity Limit Medications Amjevita 20 mg/0.4 ml prefilled syringe Amjevita (adalimumab-atto) 40 mg/0.8 ml 2 #* ^ prefilled
More informationContributions to health outcomes research Rheumatoid Arthritis. Study objective: Database: Author: Version: Date:
Contributions to health outcomes research Rheumatoid Arthritis Study objective: Database: Author: Version: Date: Analysis of patient journeys and their resource consumptions in Germany Insurants presenting
More informationClinical Guideline. Rheumatoid Arthritis Drug Treatment Pathway
Clinical Guideline Rheumatoid Arthritis Drug Treatment Pathway Guideline Summary This clinical guideline outlines the biologic treatment pathway for adult patients with rheumatoid arthritis. Bexley/Bromley/Greenwich/Lambeth/Lewisham
More informationDrug Class Prior Authorization Criteria Therapeutic Agents in Rheumatic and Inflammatory Diseases
Drug Class Prior Authorization Criteria Therapeutic Agents in Rheumatic and Inflammatory Diseases Line of Business: Medicaid P & T Approval Date: August 16, 2017 Effective Date: August 16, 2017 This policy
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Actemra) Reference Number: HIM.PA.SP32 Effective Date: 05/17 Last Review Date: Line of Business: Health Insurance Marketplace Coding Implications Revision Log See Important Reminder at
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Outcome High Priority
Quality ID #410: Psoriasis: Clinical Response to Systemic Medications National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes Meaningful Measure Area: Management of Chronic
More informationGolimumab: In Combination with Methotrexate as Once Monthly Treatment for Moderate to Severe Rheumatoid Arthritis
Clinical Medicine Reviews in Therapeutics Review Golimumab: In Combination with Methotrexate as Once Monthly Treatment for Moderate to Severe Rheumatoid Arthritis Lauren Keyser McCluggage 1 and Kelly Michelle
More informationClinical Guideline. Rheumatoid Arthritis Drug Treatment Pathway
Clinical Guideline Rheumatoid Arthritis Drug Treatment Pathway Guideline Summary This clinical guideline outlines the biologic treatment pathway for adult patients with rheumatoid arthritis. Bexley/Bromley/Greenwich/Lambeth/Lewisham
More informationNational Institute for Health and Clinical Excellence SCOPE. Rheumatoid arthritis: the management and treatment of rheumatoid arthritis in adults
National Institute for Health and Clinical Excellence 1 Guideline title SCOPE Rheumatoid arthritis: the management and treatment of rheumatoid arthritis in adults 1.1 Short title Rheumatoid arthritis 2
More informationSimponi / Simponi ARIA (golimumab)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.51 Subject: Simponi / Simponi ARIA Page: 1 of 6 Last Review Date: September 15, 2016 Simponi / Simponi
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Otezla (apremilast) Page 1 of 7 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Otezla (apremilast) Prime Therapeutics will review Prior Authorization requests Prior
More informationCarelirst.+.V Family of health care plans
Carelirst.+.V Family of health care plans CVS Caremark POLICY Document for ACTEMRA The overall objective of this policy is to support the appropriate and cost effective use of the medication, specific
More informationPerioperative Medicine:
Perioperative Medicine: Management of rheumatologic agents Divya Gollapudi, MD May 2016 Medical Operative Consult Clinic Harborview Medical Center Your patient Ms. L is a 55 year-old F w/ h/o RA who presents
More informationPROVIDER GUIDE Required information on targeted HEDIS and Part D measures
PROVIDER GUIDE Required information on targeted HEDIS and Part D measures Visit www.atriohp.com/star-ratings-program for full measure descriptions. Contact QI@atriohp.com with any questions. Adult Body
More informationMedication Policy Manual. Topic: Otezla, apremilast Date of Origin: May 9, 2014
Medication Policy Manual Policy No: dru342 Topic: Otezla, apremilast Date of Origin: May 9, 2014 Committee Approval Date: January 19, 2015 Next Review Date: January 2016 Effective Date: April 1, 2015 IMPORTANT
More informationRheumatoid Arthritis: Challenges and Opportunities in the Evolving Treatment Landscape ReachMD Page 1 of 9
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationCommon Drug Review Pharmacoeconomic Review Report
Common Drug Review Pharmacoeconomic Review Report August 2015 Drug tocilizumab (Actemra) (162 mg/0.9 ml solution for subcutaneous injection) Indication Adult patients with moderately to severely active
More informationFor Rheumatoid Arthritis
For Rheumatoid Arthritis APRIL 2017 NOTICE: On April 14, 2017 the FDA issued a complete response letter for baricitinib indicating that the FDA is unable to approve the application in its current form
More informationClinical Policy: Anakinra (Kineret) Reference Number: ERX.SPA.135 Effective Date:
Clinical Policy: (Kineret) Reference Number: ERX.SPA.135 Effective Date: 10.01.16 Last Review Date: 05.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationDrug Class Review Targeted Immune Modulators
Drug Class Review Targeted Immune Modulators Final Update 5 Report June 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
More informationRheumatoid arthritis 2010: Treatment and monitoring
October 12, 2010 By Yusuf Yazici, MD [1] The significant changes in the way rheumatoid arthritis has been managed include earlier, more aggressive treatment with combination therapy. Significant changes
More informationDrug Therapy Management
Measures At A Glance Updated: 11/01/2018 2018 Page 1 of 9 Mandatory Measures (10) Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to on an annual
More informationA Clinical Context Report
Rheumatoid Arthritis in Practice An Expert Commentary with Diane Horowitz, MD A Clinical Context Report Rheumatoid Arthritis in Practice Jointly Sponsored by: and Rheumatoid Arthritis in Practice Expert
More informationClinical Policy: Abatacept (Orencia) Reference Number: ERX.SPA.123 Effective Date:
Clinical Policy: (Orencia) Reference Number: ERX.SPA.123 Effective Date: 10.01.16 Last Review Date: 05.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationORENCIA (ABATACEPT) INJECTION FOR INTRAVENOUS INFUSION
ORENCIA (ABATACEPT) INJECTION FOR INTRAVENOUS INFUSION UnitedHealthcare Commercial Medical Benefit Drug Policy Policy Number: 2018D0039J Effective Date: March 1, 2018 Table of Contents Page INSTRUCTIONS
More informationThe Hospital for Sick Children Technology Assessment at SickKids (TASK)
The Hospital for Sick Children Technology Assessment at SickKids (TASK) THE USE OF BIOLOGIC RESPONSE MODIFIERS IN POLYARTICULAR-COURSE JUVENILE IDIOPATHIC ARTHRITIS Report No. 2010-01 Date: January 11,
More informationTrends in the Use of Biologic Agents Among Rheumatoid Arthritis Patients Enrolled in the US Medicare Program
Arthritis Care & Research Vol. 65, No. 11, November 2013, pp 1743 1751 DOI 10.1002/acr.22055 2013, American College of Rheumatology ORIGINAL ARTICLE Trends in the Use of Biologic Agents Among Rheumatoid
More informationFml Limits. Azathioprine (Imuran) 50mg, 75mg, 100mg - $26.85 Cyclosporine, 25mg, 100mg. $ Leflunomide (Arava) 10mg Tablet - $144.
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Rheumatoid Arthritis (RA) P&T DATE: 2/15/2017 CLASS: Rheumatology/Anti-inflammatory Disorders REVIEW HISTORY 2/16, 5/15,
More informationActemra (tocilizumab) CG-DRUG-81
Market DC Actemra (tocilizumab) CG-DRUG-81 Override(s) Prior Authorization Approval Duration 1 year Medications Line of Business Quantity Limit Actemra (tocilizumab) vials VA MCD and All L-AGP May be subject
More informationPredictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis
RESEARCH Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis Rishi J. Desai, PhD; Jaya K. Rao, MD; Richard A. Hansen, PhD; Gang Fang, PhD; Matthew
More informationDrug Therapy Guidelines
Simponi, Simponi Aria Applicable Medical Benefit x Effective: 2/13/18 Pharmacy- Formulary 1 x Next Review: 12/18 Pharmacy- Formulary 2 x Date of Origin: 7/2010 Pharmacy- Formulary 3/Exclusive x Review
More informationOverview of Paediatric Investigation Plan (PIP) in Paediatric Rheumatology
Overview of Paediatric Investigation Plan (PIP) in Paediatric Rheumatology Paediatric Rheumatology Expert Meeting, London 4 th December 29 Dr. Richard Veselý, Dr. Emma Sala Soriano Paediatric Investigation
More informationAntirheumatic drugs. Rheumatic Arthritis (RA)
Antirheumatic drugs Rheumatic Arthritis (RA) Disease Modifying Antirheumatic drugs (DMARDs) DMARDs are used in the treatment of rheumatic arthritis RA and have been shown to slow the course of the disease,
More informationRemicade. Remicade (infliximab), Inflectra (infliximab-dyyb) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Remicade Page: 1 of 9 Last Review Date: June 22, 2017 Remicade Description Remicade (infliximab),
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,700 108,500 1.7 M Open access books available International authors and editors Downloads Our
More informationProposed Changes to Existing Measure for HEDIS : Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
Proposed Changes to Existing Measure for HEDIS 1 2020: Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA) NCQA seeks comments on proposed modifications to the HEDIS Health
More informationCorporate Medical Policy
Corporate Medical Policy Infliximab, Infliximab-dyyb, Infliximab-abda File Name: Origination: Last CAP Review: Next CAP Review: Last Review: infliximab 5/2002 2/2018 2/2019 7/2018 Description of Procedure
More informationKineret (anakinra) When Policy Topic is covered Kineret (anakinra) requires prior authorization through the pharmacy services area.
Kineret (anakinra) Policy Number: 5.01.622 Last Review: 3/2018 Origination: 3/2017 Next Review: 3/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for Kineret (anakinra)
More informationReal-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis
Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis Jeffrey R Curtis, Fenglong Xie, Huifeng Yun, Sasha Bernatsky, Kevin L Winthrop
More informationOrencia (abatacept) for Rheumatoid Arthritis. Media backgrounder
Orencia (abatacept) for Rheumatoid Arthritis Media backgrounder What is Orencia (abatacept)? Orencia (abatacept) is the first biologic agent to be available in both an intravenous (IV) and a self-injectable,
More informationThe Medical Letter. on Drugs and Therapeutics
The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call:
More informationClinical Policy: Tofacitinib (Xeljanz, Xeljanz XR) Reference Number: ERX.SPA.110 Effective Date:
Clinical Policy: Tofacitinib (Xeljanz, Xeljanz XR) Reference Number: ERX.SPA.110 Effective Date: 10.01.16 Last Review Date: 05.18 Revision Log See Important Reminder at the end of this policy for important
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Single Technology Appraisal (STA)
Abatacept for the treatment of rheumatoid arthritis only after the failure of conventional disease-modifying anti-rheumatic drugs Thank you for agreeing to give us a statement on your organisation's view
More information