Abatacept (Orencia)

Orencia (abatacept) is covered only for FDA‑approved indications—moderately to severely active adult rheumatoid arthritis, adult psoriatic arthritis, and polyarticular juvenile idiopathic arthritis (age ≥2)—with non‑FDA uses not supported; dosing is age‑ and weight‑restricted per IV/SC regimens. Initial approval (3 months) requires indication‑specific prior‑therapy or prescriber‑specialty criteria (e.g., 3‑month trial of a biologic or csDMARD for RA; rheumatologist/dermatologist involvement for PsA; prior JIA agent or concurrent therapy, contraindication, or aggressive disease plus rheumatology oversight for JIA), documentation of diagnosis/age/weight and any contraindications, and reauthorization (12 months) requires documented clinical response.

"Orencia must be prescribed for an FDA-approved indication and meet applicable safety criteria — requests not for FDA-approved indications are not supported by this policy text."