Canakinumab (Ilaris)

Canakinumab (Ilaris) is covered only for FDA‑approved indications — CAPS (≥4 years), TRAPS, HIDS/MKD, FMF, active sJIA (≥2 years) and adult‑onset Still’s disease (≥18 years) — and off‑label uses are excluded. Coverage requires indication‑specific documentation and specialist prescribing/consult, weight‑based dosing and frequency limits, plus prior‑therapy and baseline inflammation/disease‑activity criteria (e.g., colchicine trial and CRP ≥10 mg/L or ≥2× ULN with required flare history for FMF/HIDS/TRAPS; prior biologic trials or specified exceptions for sJIA/Still’s); initial approvals ≤6 months and renewals (≤12 months) require ≥6 months on therapy with objective or symptomatic improvement.

"Cryopyrin-Associated Periodic Syndromes (CAPS) including Familial Cold Autoinflammatory Syndrome, Muckle-Wells Syndrome, and Neonatal Onset Multisystem Inflammatory Disease (NOMID)/Chronic Infantil..."