Rilonacept (Arcalyst)

Aetna covers rilonacept (J2793) for CAPS (FCAS or MWS) in patients ≥12 years with classic signs/symptoms and functional impairment; for DIRA maintenance in patients ≥10 kg with documented IL1RN mutations after induction with anakinra; and for recurrent pericarditis in patients ≥12 with ≥2 pericarditis episodes who have failed ≥2 standard therapies. All other indications and concomitant use with other biologic or targeted synthetic agents are considered experimental/investigational and excluded.

"Cryopyrin-associated periodic syndromes (CAPS) — For members 12 years or older for the treatment of CAPS when both of the following criteria are met: Member has a diagnosis of familial cold auto-in..."

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