Abatacept (Orencia®)

Orencia (abatacept) is covered only for its FDA‑approved indications—adult rheumatoid arthritis, adult psoriatic arthritis, polyarticular juvenile idiopathic arthritis (≥2 years), and acute GVHD prophylaxis (with a calcineurin inhibitor + methotrexate) for HSCT from matched or 1‑allele‑mismatched unrelated donors—and is not covered for non‑FDA uses. Coverage requires indication‑specific prerequisites (e.g., RA: 3‑month trial of a biologic or conventional DMARD; JIA: prior agent, concurrent methotrexate/leflunomide/sulfasalazine, contraindication, or aggressive disease), specialist prescribing/consultation per indication, GVHD age/donor and concomitant therapy requirements (≥2 years, CNI + methotrexate), adherence to dosing/weight limits, and reauthorization (except GVHD) after ≥6 months with documented clinical benefit.

"Re-authorization (all indications except GVHD) requires the patient to have been established on Orencia therapy for at least 6 months."