Abatacept (Orencia®)

Orencia (abatacept) is covered only for FDA‑approved indications — moderate‑to‑severe rheumatoid arthritis, active psoriatic arthritis, and polyarticular juvenile idiopathic arthritis (age ≥2) — and is excluded for non‑FDA uses. Key requirements: initial authorization (3 months) requires specified prior therapy (RA: 3‑month trial of a biologic or a conventional synthetic DMARD; JIA: prior agent trial OR concurrent start with methotrexate/leflunomide/sulfasalazine OR contraindication OR aggressive disease), prescription/consultation by the appropriate specialist (rheumatologist for RA/JIA; rheumatologist or dermatologist for PsA), adherence to age/weight‑based IV/subcutaneous dosing (IV max 1000 mg) with documented patient age/weight and dosing plan, and documented clinical response for reauthorization (renewal up to 12 months).

"Treatment of adult patients with moderately to severely active rheumatoid arthritis (reduce signs/symptoms, induce major clinical response, inhibit progression of structural damage, improve physica..."