Abatacept (Orencia)

Aetna covers abatacept (Orencia, IV or SC per labeling) for moderately-to-severely active RA in adults, RA after prior biologic/targeted synthetic therapy, polyarticular JIA and PsA in members ≥2 years (and JIA after prior biologic), with a brand-selection restriction for members new to targeted immune modulators. Key requirements: IV abatacept is permitted only if contraindication/intolerance/ineffective response to equivalent alternatives (for RA and PsA require one-month trials of Simponi Aria and Avsola or Inflectra), adult RA patients naive to biologics must meet biomarker/testing criteria and have a ≥3‑month methotrexate trial titrated to 15 mg/week unless intolerant/contraindicated, and IV abatacept has not been studied in JIA <6 years (SC dosing limited by age/weight).

"Xeljanz XR (tofacitinib, extended release) — Ankylosing Spondylitis"

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