Abatacept (Orencia)

Orencia (abatacept) is covered only for FDA‑approved indications—moderate–severe adult rheumatoid arthritis, adult psoriatic arthritis, and polyarticular juvenile idiopathic arthritis (SC ≥2 years; IV dosing guidance ≥6 years)—with off‑label/compendial uses excluded, and it must not be used with another biologic or in the presence of an active infection. Coverage requires TB screening (and treatment if latent), documentation of diagnosis and required prior therapy failures or contraindications per indication (e.g., RA: prior biologic or ≥3 months methotrexate unless contraindicated; PsA: prior biologic or methotrexate; JIA: ≥1 TNF inhibitor), adherence to age/weight dosing limits (IV/SC tiers, max 1000 mg IV), and approval is for up to 12 months with clinical improvement/stability needed for renewal.

"Documentation confirming absence of active infection (including localized infection) prior to initiation."