Arcalyst® (rilonacept)

EviCore covers Arcalyst (rilonacept) only for FDA‑approved indications — CAPS (FCAS, MWS, NOMID/CINCA) in patients ≥12 years, DIRA in patients ≥10 kg with confirmed IL1RN mutation, and recurrent pericarditis in patients ≥12 years with ≥3 prior episodes — and excludes off‑label uses. Coverage requires specialist prescribing/consultation, diagnostic confirmation (e.g., IL1RN genetic testing for DIRA), documentation of prior therapies or contraindications (e.g., NSAIDs/colchicine/steroids for pericarditis; prior anakinra benefit for DIRA), baseline objective measures and demonstration of objective or symptomatic improvement for reauthorization (≥6 months for CAPS/DIRA; ≥3 months for pericarditis), and adherence to specified dosing and approval durations.

"Arcalyst is indicated for the treatment of Cryopyrin-Associated Periodic Syndromes (CAPS), including Familial Cold Autoinflammatory Syndrome (FCAS), and Muckle-Wells Syndrome (MWS) in adults and pe..."